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Favorable neurological outcome after ischemic cerebrovascular events in patients treated with percutaneous left atrial appendage occlusion compared with warfarin
Author(s) -
Lee OhHyun,
Kim Young Dae,
Kim JungSun,
Pak HuiNam,
Hong GeuRu,
Shim Chi Young,
Uhm JaeSun,
Cho InJeong,
Joung Boyoung,
Hong SungJin,
Ahn ChulMin,
Kim ByeongKeuk,
Ko YoungGuk,
Choi Donghoon,
Hong MyeongKi,
Yu CheolWoong,
Lee HyunJong,
Kang WoongChol,
Shin EunSeok,
Choi Rakkyeong,
Lim DoSun,
Freixa Xavier,
Tzikas Apostolos,
Heo Ji Hoe,
Jang Yangsoo,
Park JaiWun
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27913
Subject(s) - medicine , atrial fibrillation , warfarin , occlusion , stroke (engine) , cardiology , modified rankin scale , percutaneous , left atrial appendage occlusion , anesthesia , ischemic stroke , ischemia , mechanical engineering , engineering
Objectives This study sought to investigate neurological disability after ischemic cerebrovascular events in patients treated with left atrial appendage (LAA) occlusion compared with those on warfarin. Background Prior studies demonstrated that cerebrovascular events after LAA occlusion in patients with nonvalvular atrial fibrillation (NVAF) is largely nondisabling. Methods From the 1,189 patients in the Korean LAA Occlusion and European Amplatzer Cardiac Plug Multi‐Center Registry, 24 patients who experienced ischemic cerebrovascular events after LAA occlusion were enrolled. The neurological outcomes were compared with those in 68 patients who experienced an ischemic cerebrovascular event while on warfarin (Yonsei Stroke Registry). A modified Rankin scale (mRS) score of 3–6 categorized the cerebrovascular event as disabling. The mRS at discharge and at 3 and 12 months postcerebrovascular event in the two groups was compared. Results The percentages of disabling cerebrovascular events were 37.5% and 58.8% at discharge ( P = 0.07), 20.8% and 42.6% at 3 months ( P = 0.08), and 12.5% and 39.7% at 12 months ( P = 0.02) in the LAA occlusion and warfarin groups, respectively. The mRS was significantly lower in the LAA occlusion group at discharge and at 3 months ( P < 0.01) and 12 months ( P < 0.01) postcerebrovascular event despite no significant difference in mRS before cerebrovascular events ( P = 0.98). Patients in the LAA occlusion group demonstrated a significant reduction in mRS between discharge and 12 months ( P < 0.01), unlike patients in the warfarin group ( P = 0.10). Conclusions Ischemic cerebrovascular events in patients who previously underwent percutaneous LAA occlusion for NVAF were more favorable than in patients on warfarin.