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Incidence, predictors, and clinical impact of bleeding recurrence in patients with prior gastrointestinal bleeding undergoing LAAC
Author(s) -
Faroux Laurent,
CruzGonzález Ignacio,
Arzamendi Dabit,
Freixa Xavier,
NombelaFranco Luis,
Peral Vicente,
CaneiroQueija Berenice,
Mangieri Antonio,
TrejoVelasco Blanca,
Asmarats Lluis,
Regueiro Ander,
McInerney Angela,
Morcuende Gonzalez Antonio,
EstevezLoureiro Rodrigo,
Laricchia Alessandra,
O'Hara Gilles,
RodésCabau Josep
Publication year - 2021
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.14293
Subject(s) - medicine , interquartile range , gastrointestinal bleeding , incidence (geometry) , stroke (engine) , gastroenterology , surgery , cardiology , mechanical engineering , physics , optics , engineering
Background Gastrointestinal bleeding (GIB) is associated with a high recurrence rate and a prior GIB episode is common in real‐world left atrial appendage closure (LAAC) recipients. The present study sought to evaluate the clinical characteristics and outcomes of patients with prior GIB undergoing LAAC, and to determine the factors associated with and clinical impact of GIB recurrence. Methods Multicenter study including 277 consecutive patients who underwent percutaneous LAAC and had prior GIB. All‐cause death, all bleeding, GIB recurrence, and clinical ischemic stroke were recorded. Results After a median follow‐up of 17 (interquartile range: 6–37) months post‐LAAC, the rates of death, bleeding, GIB recurrence, and ischemic stroke were 14.0 per 100 person‐year (PY), 29.3 per 100 PY, 17.7 per 100 PY, and 1.1 per 100 PY, respectively. GIB recurrence occurred within 3 months post‐LAAC in 55.8% of patients. A previous lower GIB (vs. upper or unclassified) (HR: 1.76; 95% CI: 1.09‐2.82; p = .020) and eGFR < 45 mL/min (HR: 1.70; 95% CI:1.04‐2.67; p = .033) determined an increased risk of GIB recurrence. By multivariable analysis, eGFR < 45 mL/min (HR: 2.72; 95% CI: 1.70‐4.34; p < .001), GIB recurrence following LAAC (HR: 2.15; 95% CI: 1.33‐3.46; p = .002), diabetes mellitus (HR: 1.77; 95% CI: 1.10‐2.84; p = .018), and age (HR: 1.06; 95% CI: 1.03‐1.10; p < .001) were associated with an increased mortality. Conclusions Patients with prior GIB undergoing LAAC exhibited a relatively low rate of GIB recurrence, and prior lower GIB and moderate‐to‐severe chronic kidney disease determined an increased risk. GIB recurrence was associated with an increased mortality.