Left atrial appendage occlusion vs oral anticoagulants in AF and coronary stenting. The DESAFIO registry
ABSTRACT Introduction and objectives: The treatment of patients with non-valvular atrial fibrillation (NVAF) who need coronary stenting is challenging. The objective of the study was to determine whether left atrial appendage occlusion (LAAO) could be a feasible option and benefit these patients. To...
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Permanyer
2023-11-01
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| Series: | REC: Interventional Cardiology (English Ed.) |
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| Online Access: | https://recintervcardiol.org/en/index.php?option=com_content&view=article&id=1122 |
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| author | José Ramón López-Mínguez Estrella Suárez-Corchuelo Sergio López-Tejero Luis Nombela-Franco Xavier Freixa-Rofastes Guillermo Bastos-Fernández Xavier Millán-Álvarez Raúl Moreno-Gómez José Antonio Fernández-Díaz Ignacio Amat-Santos Tomás Benito-González Fernando Alfonso-Manterola Pablo Salinas-Sanguino Pedro Cepas-Guillén Dabit Arzamendi Ignacio Cruz-González Juan Manuel Nogales-Asensio |
| author_facet | José Ramón López-Mínguez Estrella Suárez-Corchuelo Sergio López-Tejero Luis Nombela-Franco Xavier Freixa-Rofastes Guillermo Bastos-Fernández Xavier Millán-Álvarez Raúl Moreno-Gómez José Antonio Fernández-Díaz Ignacio Amat-Santos Tomás Benito-González Fernando Alfonso-Manterola Pablo Salinas-Sanguino Pedro Cepas-Guillén Dabit Arzamendi Ignacio Cruz-González Juan Manuel Nogales-Asensio |
| author_sort | José Ramón López-Mínguez |
| collection | DOAJ |
| description | ABSTRACT Introduction and objectives: The treatment of patients with non-valvular atrial fibrillation (NVAF) who need coronary stenting is challenging. The objective of the study was to determine whether left atrial appendage occlusion (LAAO) could be a feasible option and benefit these patients. To this end, we studied the impact of LAAO plus antiplatelet drugs vs oral anticoagulants (OAC) (including direct OAC) plus antiplatelet drugs in these patients’ long-term outcomes. Methods: The results of 207 consecutive patients with NVAF who underwent coronary stenting were analyzed. A total of 146 patients were treated with OAC (75 with acenocoumarol, 71 with direct OAC) while 61 underwent LAAO. The median follow-up was 35 months. Patients also received antiplatelet therapy as prescribed by their cardiologist. The study received the proper ethical oversight. Results: Age (mean 75.7 years), and the past medical history of stroke were similar in both groups. However, the LAAO group had more unfavorable characteristics (history of coronary artery disease [CHA2DS2-VASc], and significant bleeding [BARC ≥ 2] and HAS-BLED). The occurrence of major adverse events (death, stroke/transient ischemic events, major bleeding) and major cardiovascular events (cardiac death, stroke/transient ischemic attack, and myocardial infarction) were significantly higher in the OAC group compared to the LAAO group: 19.75% vs 9.06% (HR, 2.18; P.= .008) and 6.37% vs 1.91% (HR, 3.34; P.= .037), respectively. Conclusions: In patients with NVAF undergoing coronary stenting, LAAO plus antiplatelet therapy produced better long-term outcomes compared to treatment with OAC plus antiplatelet therapy despite the unfavorable baseline characteristics of the LAAO group. |
| first_indexed | 2024-03-11T12:09:32Z |
| format | Article |
| id | doaj.art-2d16c2a00d7843c19b7a0b46a396b3bb |
| institution | Directory Open Access Journal |
| issn | 2604-7322 |
| language | English |
| last_indexed | 2024-03-11T12:09:32Z |
| publishDate | 2023-11-01 |
| publisher | Permanyer |
| record_format | Article |
| series | REC: Interventional Cardiology (English Ed.) |
| spelling | doaj.art-2d16c2a00d7843c19b7a0b46a396b3bb2023-11-07T14:49:21ZengPermanyerREC: Interventional Cardiology (English Ed.)2604-73222023-11-015428729610.24875/RECICE.M23000386Left atrial appendage occlusion vs oral anticoagulants in AF and coronary stenting. The DESAFIO registryJosé Ramón López-Mínguez0Estrella Suárez-Corchuelo1Sergio López-Tejero2Luis Nombela-Franco3Xavier Freixa-Rofastes4Guillermo Bastos-Fernández5Xavier Millán-Álvarez6Raúl Moreno-Gómez7José Antonio Fernández-Díaz8Ignacio Amat-Santos9Tomás Benito-González10Fernando Alfonso-Manterola11Pablo Salinas-Sanguino12Pedro Cepas-Guillén13Dabit Arzamendi14Ignacio Cruz-González15Juan Manuel Nogales-Asensio16Sección de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de Badajoz, Badajoz, SpainSección de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de Badajoz, Badajoz, SpainSección de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, SpainCentro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), SpainSección de Cardiología Intervencionista, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos Madrid, SpainSección de Cardiología Intervencionista, Servicio de Cardiología, Hospital Clínico de Barcelona, Barcelona, SpainSección de Cardiología Intervencionista, Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, SpainSección de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, SpainSección de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de La Paz, IdiPAZ, Madrid, SpainSección de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de Puerta de Hierro, Majadahonda, Madrid, SpainSección de Cardiología Intervencionista, Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, SpainSección de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de León, León, SpainCentro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), SpainSección de Cardiología Intervencionista, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos Madrid, SpainSección de Cardiología Intervencionista, Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, SpainSección de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, SpainSección de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de Badajoz, Badajoz, SpainABSTRACT Introduction and objectives: The treatment of patients with non-valvular atrial fibrillation (NVAF) who need coronary stenting is challenging. The objective of the study was to determine whether left atrial appendage occlusion (LAAO) could be a feasible option and benefit these patients. To this end, we studied the impact of LAAO plus antiplatelet drugs vs oral anticoagulants (OAC) (including direct OAC) plus antiplatelet drugs in these patients’ long-term outcomes. Methods: The results of 207 consecutive patients with NVAF who underwent coronary stenting were analyzed. A total of 146 patients were treated with OAC (75 with acenocoumarol, 71 with direct OAC) while 61 underwent LAAO. The median follow-up was 35 months. Patients also received antiplatelet therapy as prescribed by their cardiologist. The study received the proper ethical oversight. Results: Age (mean 75.7 years), and the past medical history of stroke were similar in both groups. However, the LAAO group had more unfavorable characteristics (history of coronary artery disease [CHA2DS2-VASc], and significant bleeding [BARC ≥ 2] and HAS-BLED). The occurrence of major adverse events (death, stroke/transient ischemic events, major bleeding) and major cardiovascular events (cardiac death, stroke/transient ischemic attack, and myocardial infarction) were significantly higher in the OAC group compared to the LAAO group: 19.75% vs 9.06% (HR, 2.18; P.= .008) and 6.37% vs 1.91% (HR, 3.34; P.= .037), respectively. Conclusions: In patients with NVAF undergoing coronary stenting, LAAO plus antiplatelet therapy produced better long-term outcomes compared to treatment with OAC plus antiplatelet therapy despite the unfavorable baseline characteristics of the LAAO group.https://recintervcardiol.org/en/index.php?option=com_content&view=article&id=1122Stents Atrial appendage Atrial fibrillation Anticoagulants |
| spellingShingle | José Ramón López-Mínguez Estrella Suárez-Corchuelo Sergio López-Tejero Luis Nombela-Franco Xavier Freixa-Rofastes Guillermo Bastos-Fernández Xavier Millán-Álvarez Raúl Moreno-Gómez José Antonio Fernández-Díaz Ignacio Amat-Santos Tomás Benito-González Fernando Alfonso-Manterola Pablo Salinas-Sanguino Pedro Cepas-Guillén Dabit Arzamendi Ignacio Cruz-González Juan Manuel Nogales-Asensio Left atrial appendage occlusion vs oral anticoagulants in AF and coronary stenting. The DESAFIO registry REC: Interventional Cardiology (English Ed.) Stents Atrial appendage Atrial fibrillation Anticoagulants |
| title | Left atrial appendage occlusion vs oral anticoagulants in AF and coronary stenting. The DESAFIO registry |
| title_full | Left atrial appendage occlusion vs oral anticoagulants in AF and coronary stenting. The DESAFIO registry |
| title_fullStr | Left atrial appendage occlusion vs oral anticoagulants in AF and coronary stenting. The DESAFIO registry |
| title_full_unstemmed | Left atrial appendage occlusion vs oral anticoagulants in AF and coronary stenting. The DESAFIO registry |
| title_short | Left atrial appendage occlusion vs oral anticoagulants in AF and coronary stenting. The DESAFIO registry |
| title_sort | left atrial appendage occlusion vs oral anticoagulants in af and coronary stenting the desafio registry |
| topic | Stents Atrial appendage Atrial fibrillation Anticoagulants |
| url | https://recintervcardiol.org/en/index.php?option=com_content&view=article&id=1122 |
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