Symptomatic vs. non-symptomatic device-related thrombus after LAAC: a sub-analysis from the multicenter EUROC-DRT registry.
Atrial fibrillation
Device-related thrombus
Left atrial appendage closure
Stroke
Journal
Clinical research in cardiology : official journal of the German Cardiac Society
ISSN: 1861-0692
Titre abrégé: Clin Res Cardiol
Pays: Germany
ID NLM: 101264123
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
received:
14
02
2023
accepted:
23
05
2023
medline:
6
12
2023
pubmed:
9
6
2023
entrez:
9
6
2023
Statut:
ppublish
Résumé
Device-related thrombus (DRT) after left atrial appendage closure (LAAC) is associated with adverse outcomes, i.e. ischemic stroke or systemic embolism (SE). Data on predictors of stroke/SE in the context of DRT are limited. This study aimed to identify predisposing factors for stroke/SE in DRT patients. In addition, the temporal connection of stroke/SE to DRT diagnosis was analyzed. The EUROC-DRT registry included 176 patients, in whom DRT after LAAC were diagnosed. Patients with symptomatic DRT, defined as stroke/SE in the context of DRT diagnosis, were compared against patients with non-symptomatic DRT. Baseline characteristics, anti-thrombotic regimens, device position, and timing of stroke/SE were compared. Stroke/SE occurred in 25/176 (14.2%) patients diagnosed with DRT (symptomatic DRT). Stroke/SE occurred after a median of 198 days (IQR 37-558) after LAAC. In 45.8% stroke/SE occurred within one month before/after DRT diagnosis (DRT-related stroke). Patients with symptomatic DRT had lower left ventricular ejection fractions (50.0 ± 9.1% vs. 54.2 ± 11.0%, p = 0.03) and higher rates of non-paroxysmal atrial fibrillation (84.0% vs. 64.9%, p = 0.06). Other baseline parameters and device positions were not different. Most ischemic events occurred among patients with single antiplatelet therapy (50%), however, stroke/SE was also observed under dual antiplatelet therapy (25%) or oral anticoagulation (20%). Stroke/SE are documented in 14.2% and occur both in close temporal relation to the DRT finding and chronologically independently therefrom. Identification of risk factors remains cumbersome, putting all DRT patients at substantial risk for stroke/SE. Further studies are necessary to minimize the risk of DRT and ischemic events.
Sections du résumé
BACKGROUND
BACKGROUND
Device-related thrombus (DRT) after left atrial appendage closure (LAAC) is associated with adverse outcomes, i.e. ischemic stroke or systemic embolism (SE). Data on predictors of stroke/SE in the context of DRT are limited.
AIMS
OBJECTIVE
This study aimed to identify predisposing factors for stroke/SE in DRT patients. In addition, the temporal connection of stroke/SE to DRT diagnosis was analyzed.
METHODS
METHODS
The EUROC-DRT registry included 176 patients, in whom DRT after LAAC were diagnosed. Patients with symptomatic DRT, defined as stroke/SE in the context of DRT diagnosis, were compared against patients with non-symptomatic DRT. Baseline characteristics, anti-thrombotic regimens, device position, and timing of stroke/SE were compared.
RESULTS
RESULTS
Stroke/SE occurred in 25/176 (14.2%) patients diagnosed with DRT (symptomatic DRT). Stroke/SE occurred after a median of 198 days (IQR 37-558) after LAAC. In 45.8% stroke/SE occurred within one month before/after DRT diagnosis (DRT-related stroke). Patients with symptomatic DRT had lower left ventricular ejection fractions (50.0 ± 9.1% vs. 54.2 ± 11.0%, p = 0.03) and higher rates of non-paroxysmal atrial fibrillation (84.0% vs. 64.9%, p = 0.06). Other baseline parameters and device positions were not different. Most ischemic events occurred among patients with single antiplatelet therapy (50%), however, stroke/SE was also observed under dual antiplatelet therapy (25%) or oral anticoagulation (20%).
CONCLUSION
CONCLUSIONS
Stroke/SE are documented in 14.2% and occur both in close temporal relation to the DRT finding and chronologically independently therefrom. Identification of risk factors remains cumbersome, putting all DRT patients at substantial risk for stroke/SE. Further studies are necessary to minimize the risk of DRT and ischemic events.
Identifiants
pubmed: 37294311
doi: 10.1007/s00392-023-02237-w
pii: 10.1007/s00392-023-02237-w
pmc: PMC10697873
doi:
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1790-1799Informations de copyright
© 2023. The Author(s).
Références
Circ Cardiovasc Interv. 2021 May;14(5):e010195
pubmed: 34003661
Circulation. 2021 Nov 9;144(19):1543-1552
pubmed: 34459659
J Am Coll Cardiol. 2021 Jul 27;78(4):297-313
pubmed: 34294267
JACC Cardiovasc Interv. 2010 Aug;3(8):870-7
pubmed: 20723861
J Am Coll Cardiol. 2018 Apr 10;71(14):1528-1536
pubmed: 29622159
JACC Cardiovasc Interv. 2019 Jun 10;12(11):1003-1014
pubmed: 31103540
EuroIntervention. 2016 Feb;11(10):1170-9
pubmed: 25604089
Interv Cardiol. 2019 Feb;14(1):42-44
pubmed: 30858891
Circ Cardiovasc Interv. 2018 Mar;11(3):e005997
pubmed: 29463510
JACC Clin Electrophysiol. 2018 Dec;4(12):1629-1637
pubmed: 30573129
J Cardiovasc Dev Dis. 2021 Oct 28;8(11):
pubmed: 34821695
Catheter Cardiovasc Interv. 2021 Jun 1;97(7):E1019-E1024
pubmed: 33417282
Circulation. 2018 Aug 28;138(9):874-885
pubmed: 29752398
Circ Cardiovasc Interv. 2020 Jul;13(7):e008481
pubmed: 32674675
Circulation. 2022 Mar 8;145(10):724-738
pubmed: 34747186
BMC Cardiovasc Disord. 2020 Feb 12;20(1):78
pubmed: 32050904
Circulation. 2011 Feb 1;123(4):417-24
pubmed: 21242484
Eur Heart J. 2021 Mar 7;42(10):1047-1048
pubmed: 33167004
Clin Res Cardiol. 2022 Nov;111(11):1276-1285
pubmed: 35849156
Circ Cardiovasc Interv. 2021 Nov;14(11):e010889
pubmed: 34706552
Eur Heart J. 2020 Aug 7;41(30):2894-2901
pubmed: 32243499