Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion.

Autor:	Simard T; Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA. Electronic address: https://twitter.com/tjsimard., Jung RG; Capital Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada., Lehenbauer K; Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA., Piayda K; CardioVascular Center Frankfurt, Frankfurt, Germany; Heinrich-Heine-University, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany., Pracoń R; Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland., Jackson GG; Vanderbilt Heart and Vascular Institute, Nashville, Tennessee, USA., Flores-Umanzor E; Department of Cardiology, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain., Faroux L; Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada., Korsholm K; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark., Chun JKR; Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Germany., Chen S; Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Germany., Maarse M; Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands; LB Amsterdam University Medical Center, Amsterdam, the Netherlands., Montrella K; University of Pittsburgh Medical Center Heart and Vascular Institute, University of Pittsburgh, Altoona, Pennsylvania, USA., Chaker Z; Division of Cardiology, West Virginia School of Medicine, Morgantown, West Virginia, USA., Spoon JN; International Heart Institute of Montana, Missoula, Montana, USA., Pastormerlo LE; Fondazione Toscana Gabriele Monasterio Massa, Scuola Superiore Sant'Anna, Pisa, Italy., Meincke F; Asklepios Klinik St Georg, Hamburg, Germany., Sawant AC; Banner University Medical Center, Phoenix, Arizona, USA., Moldovan CM; Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland., Qintar M; Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA., Aktas MK; Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA., Branca L; Catheterization Laboratory, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy., Radinovic A; Arrhythmology Department, San Raffaele University Hospital, Milan, Italy., Ram P; Emory University Hospital, Atlanta, Georgia, USA., El-Zein RS; Division of Cardiology, OhioHealth Doctors Hospital/OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA., Flautt T; Houston Methodist Hospital, Houston, Texas, USA., Ding WY; Liverpool Heart and Chest Hospital, Liverpool, United Kingdom., Sayegh B; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; The Heart, Lung and Vascular Institute, Excela Health, Pittsburgh, Pennsylvania, USA., Benito-González T; Department of Cardiology, University Hospital of León, León, Spain., Lee OH; Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea., Badejoko SO; Division of Internal Medicine, St Joseph's Medical Center (Dignity Health), Stockton, California, USA., Paitazoglou C; Cardiologicum Hamburg, Hamburg, Germany., Karim N; Royal Brompton and Harefield Hospitals, Part of Guys' and St Thomas' National Health Service Foundation Trust, London, United Kingdom., Zaghloul AM; Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA., Agrawal H; Creighton University School of Medicine, Omaha, Nebraska, USA., Kaplan RM; Northwestern University, Bluhm Cardiovascular Institute, Chicago, Illinois, USA., Alli O; Division of Cardiology, Novant Health Heart and Vascular Institute, Charlotte, North Carolina, USA., Ahmed A; Rush University Medical Center, Chicago, Illinois, USA., Suradi HS; Rush University Medical Center, Chicago, Illinois, USA., Knight BP; Northwestern University, Bluhm Cardiovascular Institute, Chicago, Illinois, USA., Alla VM; Creighton University School of Medicine, Omaha, Nebraska, USA., Panaich SS; Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA., Wong T; Royal Brompton and Harefield Hospitals, Part of Guys' and St Thomas' National Health Service Foundation Trust, London, United Kingdom., Bergmann MW; Cardiologicum Hamburg, Hamburg, Germany., Chothia R; Division of Internal Medicine, St Joseph's Medical Center (Dignity Health), Stockton, California, USA., Kim JS; Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea., Pérez de Prado A; Department of Cardiology, University Hospital of León, León, Spain., Bazaz R; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA., Gupta D; Liverpool Heart and Chest Hospital, Liverpool, United Kingdom., Valderrabano M; Houston Methodist Hospital, Houston, Texas, USA., Sanchez CE; Division of Cardiology, OhioHealth Doctors Hospital/OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA., El Chami MF; Emory University Hospital, Atlanta, Georgia, USA., Mazzone P; Arrhythmology Department, San Raffaele University Hospital, Milan, Italy., Adamo M; Catheterization Laboratory, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy., Ling F; Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA., Wang DD; Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA., O'Neill W; Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA., Wojakowski W; Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland., Pershad A; Banner University Medical Center, Phoenix, Arizona, USA., Berti S; Fondazione Toscana Gabriele Monasterio Massa, Scuola Superiore Sant'Anna, Pisa, Italy., Spoon D; International Heart Institute of Montana, Missoula, Montana, USA., Kawsara A; Division of Cardiology, West Virginia School of Medicine, Morgantown, West Virginia, USA., Jabbour G; University of Pittsburgh Medical Center Heart and Vascular Institute, University of Pittsburgh, Altoona, Pennsylvania, USA., Boersma LVA; Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands; LB Amsterdam University Medical Center, Amsterdam, the Netherlands., Schmidt B; Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markuskrankenhaus, Frankfurt, Germany., Nielsen-Kudsk JE; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark., Rodés-Cabau J; Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada., Freixa X; Department of Cardiology, Hospital Clinic of Barcelona, August Pi I Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain., Ellis CR; Vanderbilt Heart and Vascular Institute, Nashville, Tennessee, USA., Fauchier L; Service de Cardiologie, Centre Hospitalier Universitaire Trousseau Faculté de Médecine, Université François Rabelais, Tours, France., Demkow M; Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland., Sievert H; CardioVascular Center Frankfurt, Frankfurt, Germany., Main ML; Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA., Hibbert B; Capital Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada., Holmes DR Jr; Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA., Alkhouli M; Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA. Electronic address: Alkhouli.Mohamad@mayo.edu.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Cardiology [J Am Coll Cardiol] 2021 Jul 27; Vol. 78 (4), pp. 297-313.
DOI:	10.1016/j.jacc.2021.04.098
Abstrakt:	Background: Device-related thrombus (DRT) has been considered an Achilles' heel of left atrial appendage occlusion (LAAO). However, data on DRT prediction remain limited. Objectives: This study constructed a DRT registry via a multicenter collaboration aimed to assess outcomes and predictors of DRT. Methods: Thirty-seven international centers contributed LAAO cases with and without DRT (device-matched and temporally related to the DRT cases). This study described the management patterns and mid-term outcomes of DRT and assessed patient and procedural predictors of DRT. Results: A total of 711 patients (237 with and 474 without DRT) were included. Follow-up duration was similar in the DRT and no-DRT groups, median 1.8 years (interquartile range: 0.9-3.0 years) versus 1.6 years (interquartile range: 1.0-2.9 years), respectively (P = 0.76). DRTs were detected between days 0 to 45, 45 to 180, 180 to 365, and >365 in 24.9%, 38.8%, 16.0%, and 20.3% of patients. DRT presence was associated with a higher risk of the composite endpoint of death, ischemic stroke, or systemic embolization (HR: 2.37; 95% CI, 1.58-3.56; P < 0.001) driven by ischemic stroke (HR: 3.49; 95% CI: 1.35-9.00; P = 0.01). At last known follow-up, 25.3% of patients had DRT. Discharge medications after LAAO did not have an impact on DRT. Multivariable analysis identified 5 DRT risk factors: hypercoagulability disorder (odds ratio [OR]: 17.50; 95% CI: 3.39-90.45), pericardial effusion (OR: 13.45; 95% CI: 1.46-123.52), renal insufficiency (OR: 4.02; 95% CI: 1.22-13.25), implantation depth >10 mm from the pulmonary vein limbus (OR: 2.41; 95% CI: 1.57-3.69), and non-paroxysmal atrial fibrillation (OR: 1.90; 95% CI: 1.22-2.97). Following conversion to risk factor points, patients with ≥2 risk points for DRT had a 2.1-fold increased risk of DRT compared with those without any risk factors. Conclusions: DRT after LAAO is associated with ischemic events. Patient- and procedure-specific factors are associated with the risk of DRT and may aid in risk stratification of patients referred for LAAO. Competing Interests: Funding Support and Author Disclosures Dr Maarse has received an unrestricted grant from Boston Scientific. Dr Pérez de Prado has served as a proctor for Boston Scientific. Dr Gupta has served as a proctor for Abbott. Dr Sanchez has served as a speaker and proctor for Boston Scientific. Dr Demkow has served as a proctor for Abbott and Boston Scientific. Dr Alkhouli has served as a consultant for Boston Scientific. Dr Wang has been a consultant for Edwards LifeSciences, Boston Scientific, and Neochord; and has received research grant support from Boston Scientific assigned to employer Henry Ford health system. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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