Comparative analysis of left atrial appendage closure efficacy and outcomes by CHA2DS2-VASc score group in patients with non-valvular atrial fibrillation
BackgroundHigher CHA2DS2-VASc score is associated with an increased risk of adverse cardio-cerebrovascular events in patients with non-valvular atrial fibrillation (NVAF), regardless of oral anticoagulation (OAC) status. However, whether this association still exists in patients undergoing left atri...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-07-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.905728/full |
| _version_ | 1811288354881273856 |
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| author | Mingzhong Zhao Mingzhong Zhao Mengxi Zhao Cody R. Hou Felix Post Nora Herold Jens Walsleben Qingru Yuan Zhaohui Meng Zhaohui Meng Jiangtao Yu Jiangtao Yu |
| author_facet | Mingzhong Zhao Mingzhong Zhao Mengxi Zhao Cody R. Hou Felix Post Nora Herold Jens Walsleben Qingru Yuan Zhaohui Meng Zhaohui Meng Jiangtao Yu Jiangtao Yu |
| author_sort | Mingzhong Zhao |
| collection | DOAJ |
| description | BackgroundHigher CHA2DS2-VASc score is associated with an increased risk of adverse cardio-cerebrovascular events in patients with non-valvular atrial fibrillation (NVAF), regardless of oral anticoagulation (OAC) status. However, whether this association still exists in patients undergoing left atrial appendage closure (LAAC) is unknown. We evaluated the impact of CHA2DS2-VASc score on LAAC efficacy and outcomes.MethodsA total of 401 consecutive patients undergoing LAAC were included and divided into 3 groups based on CHA2DS2-VASc score (0–2, 3–4, and ≥5). Baseline characteristics, periprocedural complications, and long-term outcomes were collected and compared across all groups.ResultsThere were no significant differences in implantation success, periprocedural complications, and long-term outcomes across all score groups. Kaplan-Meier estimation showed that the cumulative ratio of freedom from all-cause mortality (P = 0.146), cardiovascular mortality (P = 0.519), and non-cardiovascular mortality (P = 0.168) did not differ significantly by CHA2DS2-VASc score group. LAAC decreased the risks of thromboembolism and major bleeding, resulting in a relative risk reduction (RRR) of 82.4% (P < 0.001) and 66.7% (P < 0.001) compared with expected risks in the overall cohort, respectively. Subgroup analysis indicated that observed risks of thromboembolism and major bleeding were significantly lower than the expected risks in score 3–4 and score ≥5 groups, respectively. The level of RRR increased with CHA2DS2-VASc score (P < 0.001 for trend) for thromboembolism but not for major bleeding (P = 0.2729 for trend).ConclusionPatients with higher CHA2DS2-VASc score did not experience worse outcomes, which may be partly attributed to more benefits provided by LAAC intervention in such patients compared to those with a low score. |
| first_indexed | 2024-04-13T03:35:38Z |
| format | Article |
| id | doaj.art-1e6c168daa174db0815c1937149c8275 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-13T03:35:38Z |
| publishDate | 2022-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-1e6c168daa174db0815c1937149c82752022-12-22T03:04:20ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-07-01910.3389/fcvm.2022.905728905728Comparative analysis of left atrial appendage closure efficacy and outcomes by CHA2DS2-VASc score group in patients with non-valvular atrial fibrillationMingzhong Zhao0Mingzhong Zhao1Mengxi Zhao2Cody R. Hou3Felix Post4Nora Herold5Jens Walsleben6Qingru Yuan7Zhaohui Meng8Zhaohui Meng9Jiangtao Yu10Jiangtao Yu11Heart Center, Zhengzhou Ninth People's Hospital, Zhengzhou, ChinaDepartment of Cardiology, Helmut-G.-Walther-Klinikum, Lichtenfels, GermanyDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaCardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, United StatesClinic for General Internal Medicine and Cardiology, Catholic Medical Center Koblenz-Montabaur, Koblenz, GermanyClinic for General Internal Medicine and Cardiology, Catholic Medical Center Koblenz-Montabaur, Koblenz, GermanyClinic for General Internal Medicine and Cardiology, Catholic Medical Center Koblenz-Montabaur, Koblenz, GermanyHeart Center, Zhengzhou Ninth People's Hospital, Zhengzhou, ChinaDepartment of Cardiology, Helmut-G.-Walther-Klinikum, Lichtenfels, GermanyDepartment of Cardiology, Kunming Medical University, Kunming, ChinaDepartment of Cardiology, Helmut-G.-Walther-Klinikum, Lichtenfels, GermanyClinic for General Internal Medicine and Cardiology, Catholic Medical Center Koblenz-Montabaur, Koblenz, GermanyBackgroundHigher CHA2DS2-VASc score is associated with an increased risk of adverse cardio-cerebrovascular events in patients with non-valvular atrial fibrillation (NVAF), regardless of oral anticoagulation (OAC) status. However, whether this association still exists in patients undergoing left atrial appendage closure (LAAC) is unknown. We evaluated the impact of CHA2DS2-VASc score on LAAC efficacy and outcomes.MethodsA total of 401 consecutive patients undergoing LAAC were included and divided into 3 groups based on CHA2DS2-VASc score (0–2, 3–4, and ≥5). Baseline characteristics, periprocedural complications, and long-term outcomes were collected and compared across all groups.ResultsThere were no significant differences in implantation success, periprocedural complications, and long-term outcomes across all score groups. Kaplan-Meier estimation showed that the cumulative ratio of freedom from all-cause mortality (P = 0.146), cardiovascular mortality (P = 0.519), and non-cardiovascular mortality (P = 0.168) did not differ significantly by CHA2DS2-VASc score group. LAAC decreased the risks of thromboembolism and major bleeding, resulting in a relative risk reduction (RRR) of 82.4% (P < 0.001) and 66.7% (P < 0.001) compared with expected risks in the overall cohort, respectively. Subgroup analysis indicated that observed risks of thromboembolism and major bleeding were significantly lower than the expected risks in score 3–4 and score ≥5 groups, respectively. The level of RRR increased with CHA2DS2-VASc score (P < 0.001 for trend) for thromboembolism but not for major bleeding (P = 0.2729 for trend).ConclusionPatients with higher CHA2DS2-VASc score did not experience worse outcomes, which may be partly attributed to more benefits provided by LAAC intervention in such patients compared to those with a low score.https://www.frontiersin.org/articles/10.3389/fcvm.2022.905728/fullatrial fibrillationCHA2DS2-VASc scoreleft atrial appendage closureoutcomesstrokemajor bleeding |
| spellingShingle | Mingzhong Zhao Mingzhong Zhao Mengxi Zhao Cody R. Hou Felix Post Nora Herold Jens Walsleben Qingru Yuan Zhaohui Meng Zhaohui Meng Jiangtao Yu Jiangtao Yu Comparative analysis of left atrial appendage closure efficacy and outcomes by CHA2DS2-VASc score group in patients with non-valvular atrial fibrillation Frontiers in Cardiovascular Medicine atrial fibrillation CHA2DS2-VASc score left atrial appendage closure outcomes stroke major bleeding |
| title | Comparative analysis of left atrial appendage closure efficacy and outcomes by CHA2DS2-VASc score group in patients with non-valvular atrial fibrillation |
| title_full | Comparative analysis of left atrial appendage closure efficacy and outcomes by CHA2DS2-VASc score group in patients with non-valvular atrial fibrillation |
| title_fullStr | Comparative analysis of left atrial appendage closure efficacy and outcomes by CHA2DS2-VASc score group in patients with non-valvular atrial fibrillation |
| title_full_unstemmed | Comparative analysis of left atrial appendage closure efficacy and outcomes by CHA2DS2-VASc score group in patients with non-valvular atrial fibrillation |
| title_short | Comparative analysis of left atrial appendage closure efficacy and outcomes by CHA2DS2-VASc score group in patients with non-valvular atrial fibrillation |
| title_sort | comparative analysis of left atrial appendage closure efficacy and outcomes by cha2ds2 vasc score group in patients with non valvular atrial fibrillation |
| topic | atrial fibrillation CHA2DS2-VASc score left atrial appendage closure outcomes stroke major bleeding |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.905728/full |
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