학술논문
Clinical and echocardiographic risk factors for device-related thrombus after left atrial appendage closure: an analysis from the multicenter EUROC-DRT registry
Document Type
Original Paper
Author
Vij, Vivian; Piayda, Kerstin; Nelles, Dominik; Gloekler, Steffen; Galea, Roberto; Fürholz, Monika; Meier, Bernhard; Valgimigli, Marco; O’Hara, Gilles; Arzamendi, Dabit; Agudelo, Victor; Asmarats, Lluis; Freixa, Xavier; Flores-Umanzor, Eduardo; De Backer, Ole; Sondergaard, Lars; Nombela-Franco, Luis; McInerney, Angela; Korsholm, Kasper; Nielsen-Kudsk, Jens Erik; Afzal, Shazia; Zeus, Tobias; Operhalski, Felix; Schmidt, Boris; Montalescot, Gilles; Guedeney, Paul; Iriart, Xavier; Miton, Noelie; Saw, Jacqueline; Gilhofer, Thomas; Fauchier, Laurent; Veliqi, Egzon; Meincke, Felix; Petri, Nils; Nordbeck, Peter; Ognerubov, Dmitrii; Merkulov, Evgeny; Cruz-González, Ignacio; Gonzalez-Ferreiro, Rocio; Bhatt, Deepak L.; Laricchia, Alessandra; Mangieri, Antonio; Omran, Heyder; Schrickel, Jan Wilko; Rodes-Cabau, Josep; Sievert, Horst; Nickenig, Georg; Sedaghat, Alexander
Source
Clinical Research in Cardiology. 111(11):1276-1285
Subject
Language
English
ISSN
1861-0684
1861-0692
1861-0692
Abstract
Background: Data on Device-related Thrombus (DRT) after left atrial appendage closure (LAAC) remain scarce. This study aimed to investigate risk factors for DRT from centers reporting to the EUROC-DRT registry.Methods: We included 537 patients (112 with DRT and 425 without DRT) who had undergone LAAC between 12/2008 and 04/2019. Baseline and implantation characteristics, anti-thrombotic treatment and clinical outcomes were compared between both groups in uni- and multivariate analyses. Additional propensity-score matching (PSM) was conducted to focus on the role of implantation characteristics.Results: Patients with DRT showed higher rates of previous stroke/transient ischemic attack (TIA) (49.1% vs. 34.7%, p < 0.01), spontaneous echocardiographic contrast (SEC) (44.9% vs. 27.7%, p < 0.01) and lower left atrial appendage (LAA) peak emptying velocity (35.4 ± 18.5 vs. 42.4 ± 18.0 cm/s, p = 0.02). Occluders implanted in DRT patients were larger (25.5 ± 3.8 vs. 24.6 ± 3.5 mm, p = 0.03) and implanted deeper in the LAA (mean depth: 7.6 ± 4.7 vs. 5.7 ± 4.7 mm, p < 0.01). Coverage of the appendage ostium was achieved less often in DRT patients (69.5% vs. 81.5%, p < 0.01), while DRT patients were less frequently on oral anticoagulation (7.1% vs. 16.7%, p < 0.01). Multivariate analysis identified age, prior stroke/TIA and SEC as independent risk factors for DRT. After PSM, implantation depth was found to be predictive. Rates of stroke/TIA were higher in DRT patients (13.5% vs. 3.8%, Hazard Ratio: 4.21 [95%-confidence interval: 1.88–9.49], p < 0.01).Conclusions: DRT after LAAC is associated with adverse outcome and appears to be of multifactorial origin, depending on patient characteristics, anticoagulation regimen and device position.Graphical abstract: