Intracranial bleeding and associated outcomes in atrial fibrillation patients undergoing percutaneous left atrial appendage occlusion: Insights from National Inpatient Sample 2016-2020.

Autor:	Khan MZ; Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia., Shatla I; Department of Internal Medicine, Kansas University Medical Center, Kansas City, Kansas., Darden D; Division of Cardiology, Kansas City Heart Rhythm Institute, Overland Park, Kansas., Neely J; Division of Cardiovascular Medicine, University of California Davis, Sacramento, California., Mir T; Department of Medicine, Wayne State University, Detroit, Michigan., Abideen Asad ZU; Department of Internal Medicine, University of Oklahoma, Oklahoma City, Oklahoma., Agarwal S; Department of Internal Medicine, University of Oklahoma, Oklahoma City, Oklahoma., Raina S; Division of Cardiovascular Medicine, Stanford University, Stanford, California., Balla S; Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia., Singh GD; Division of Cardiovascular Medicine, University of California Davis, Sacramento, California., Srivatsa U; Division of Cardiovascular Medicine, University of California Davis, Sacramento, California., Munir MB; Division of Cardiovascular Medicine, University of California Davis, Sacramento, California.
Jazyk:	angličtina
Zdroj:	Heart rhythm O2 [Heart Rhythm O2] 2023 Jun 08; Vol. 4 (7), pp. 433-439. Date of Electronic Publication: 2023 Jun 08 (Print Publication: 2023).
DOI:	10.1016/j.hroo.2023.06.002
Abstrakt:	Background: Percutaneous left atrial appendage occlusion (LAAO) has proved to be a safer alternative for long-term anticoagulation; however, patients with a history of intracranial bleeding were excluded from large randomized clinical trials. Objective: The purpose of this study was to determine outcomes in atrial fibrillation (AF) patients with a history of intracranial bleeding undergoing percutaneous LAAO. Methods: National Inpatient Sample and International Classification of Diseases, Tenth Revision, codes were used to identify patients with AF who underwent LAAO during the years 2016-2020. Patients were stratified based on a history of intracranial bleeding vs not. The outcomes assessed in our study included complications, in-hospital mortality, and resource utilization. Result: A total of 89,300 LAAO device implantations were studied. Approximately 565 implantations (0.6%) occurred in patients with a history of intracranial bleed. History of intracranial bleeding was associated with a higher prevalence of overall complications and in-patient mortality in crude analysis. In the multivariate model adjusted for potential confounders, intracranial bleeding was found to be independently associated with in-patient mortality (adjusted odds ratio [aOR] 4.27; 95% confidence interval [CI] 1.68-10.82); overall complications (aOR 1.74; 95% CI 1.36-2.24); prolonged length of stay (aOR 2.38; 95% CI 1.95-2.92); and increased cost of hospitalization (aOR 1.28; 95% CI 1.08-1.52) after percutaneous LAAO device implantation. Conclusion: A history of intracranial bleeding was associated with adverse outcomes after percutaneous LAAO. These data, if proven in a large randomized study, can have important clinical consequences in terms of patient selection for LAAO devices. (© 2023 Heart Rhythm Society. Published by Elsevier Inc.)
Databáze:	MEDLINE
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