Left atrial appendage closure with WATCHMAN in Asian patients: 2 year outcomes from the WASP registry
Background: Left atrial appendage closure is a non-pharmacological alternative for stroke prevention in high-risk non-valvular atrial fibrillation patients, but has not been widely studied in Asian patients. The prospective WASP registry assessed real-world outcomes for patients undergoing WATCHMAN...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-06-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906719300272 |
| _version_ | 1811214694539591680 |
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| author | Karen P. Phillips Teguh Santoso Prashanthan Sanders Jeffrey Alison Jason Leung Kwai Chan Hui-Nam Pak Mann Chandavimol Kenneth M. Stein Nicole Gordon Omar Bin Razali |
| author_facet | Karen P. Phillips Teguh Santoso Prashanthan Sanders Jeffrey Alison Jason Leung Kwai Chan Hui-Nam Pak Mann Chandavimol Kenneth M. Stein Nicole Gordon Omar Bin Razali |
| author_sort | Karen P. Phillips |
| collection | DOAJ |
| description | Background: Left atrial appendage closure is a non-pharmacological alternative for stroke prevention in high-risk non-valvular atrial fibrillation patients, but has not been widely studied in Asian patients. The prospective WASP registry assessed real-world outcomes for patients undergoing WATCHMAN implant in the Asia-Pacific region. Methods: Data were collected from consecutive patients across 9 centres. Major endpoints included procedural success, safety and long-term outcomes including occurrence of bleeding, stroke/transient ischaemic attack/systemic embolism and all-cause mortality. Results: Subjects (n = 201) had a mean age of 70.8 ± 9.4 years, high stroke risk (CHA2DS2-VASc: 3.9 ± 1.7), elevated bleeding risk (HAS-BLED: 2.1 ± 1.2) with 53% patients from Asian countries. Successful implantation occurred in 98.5% of patients; 7-day device/procedure-related SAE rate was 3.0%. After 2 years of follow-up, the rates of ischaemic stroke/TIA/SE and major bleeding were 1.9 and 2.2 per 100-PY, respectively, representing relative reductions of 77% and 49% versus expected rates per risk scores. The relative risk reductions versus expected rates were more pronounced in Asians vs. Non-Asians (89% vs 62%; 77% vs 14%). Other significant findings included larger mean LAA ostium diameter for Asians vs. Non-Asians (23.4 ± 4.1 mm vs. 21.2 ± 3.2 mm, p < 0.001) and hence requirement for larger median device size (27 mm for Asians, 24 mm for non-Asians [p < 0.0001]). Conclusion: Real-world experience of left atrial appendage closure with WATCHMAN has demonstrated low peri-procedural risk, and long-term efficacy for stroke and bleeding prevention in a primarily Asian cohort. Keywords: Atrial fibrillation, Ischaemic stroke, Left atrial appendage, LAA device closure, Anticoagulant therapy |
| first_indexed | 2024-04-12T06:08:54Z |
| format | Article |
| id | doaj.art-e9236daa39de4642bfc888b2a90ccce6 |
| institution | Directory Open Access Journal |
| issn | 2352-9067 |
| language | English |
| last_indexed | 2024-04-12T06:08:54Z |
| publishDate | 2019-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj.art-e9236daa39de4642bfc888b2a90ccce62022-12-22T03:44:46ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672019-06-0123Left atrial appendage closure with WATCHMAN in Asian patients: 2 year outcomes from the WASP registryKaren P. Phillips0Teguh Santoso1Prashanthan Sanders2Jeffrey Alison3Jason Leung Kwai Chan4Hui-Nam Pak5Mann Chandavimol6Kenneth M. Stein7Nicole Gordon8Omar Bin Razali9HeartCare Partners, GenesisCare, Brisbane, Australia; Corresponding author at: Suite 212, Ramsay Specialist Centre, Greenslopes Private Hospital, Newdegate Street, Brisbane 4120, Australia.Medistra Hospital, Jakarta, IndonesiaSouth Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, AustraliaMonashHEART, Monash Health, Melbourne, AustraliaQueen Elizabeth Hospital, Hong KongYonsei University Health System, Seoul, Republic of KoreaRamathibodi Hospital, Bangkok, ThailandBoston Scientific Corp., Minneapolis, MN, USABoston Scientific Corp., Minneapolis, MN, USANational Heart Institute, Kuala Lumpur, MalaysiaBackground: Left atrial appendage closure is a non-pharmacological alternative for stroke prevention in high-risk non-valvular atrial fibrillation patients, but has not been widely studied in Asian patients. The prospective WASP registry assessed real-world outcomes for patients undergoing WATCHMAN implant in the Asia-Pacific region. Methods: Data were collected from consecutive patients across 9 centres. Major endpoints included procedural success, safety and long-term outcomes including occurrence of bleeding, stroke/transient ischaemic attack/systemic embolism and all-cause mortality. Results: Subjects (n = 201) had a mean age of 70.8 ± 9.4 years, high stroke risk (CHA2DS2-VASc: 3.9 ± 1.7), elevated bleeding risk (HAS-BLED: 2.1 ± 1.2) with 53% patients from Asian countries. Successful implantation occurred in 98.5% of patients; 7-day device/procedure-related SAE rate was 3.0%. After 2 years of follow-up, the rates of ischaemic stroke/TIA/SE and major bleeding were 1.9 and 2.2 per 100-PY, respectively, representing relative reductions of 77% and 49% versus expected rates per risk scores. The relative risk reductions versus expected rates were more pronounced in Asians vs. Non-Asians (89% vs 62%; 77% vs 14%). Other significant findings included larger mean LAA ostium diameter for Asians vs. Non-Asians (23.4 ± 4.1 mm vs. 21.2 ± 3.2 mm, p < 0.001) and hence requirement for larger median device size (27 mm for Asians, 24 mm for non-Asians [p < 0.0001]). Conclusion: Real-world experience of left atrial appendage closure with WATCHMAN has demonstrated low peri-procedural risk, and long-term efficacy for stroke and bleeding prevention in a primarily Asian cohort. Keywords: Atrial fibrillation, Ischaemic stroke, Left atrial appendage, LAA device closure, Anticoagulant therapyhttp://www.sciencedirect.com/science/article/pii/S2352906719300272 |
| spellingShingle | Karen P. Phillips Teguh Santoso Prashanthan Sanders Jeffrey Alison Jason Leung Kwai Chan Hui-Nam Pak Mann Chandavimol Kenneth M. Stein Nicole Gordon Omar Bin Razali Left atrial appendage closure with WATCHMAN in Asian patients: 2 year outcomes from the WASP registry International Journal of Cardiology: Heart & Vasculature |
| title | Left atrial appendage closure with WATCHMAN in Asian patients: 2 year outcomes from the WASP registry |
| title_full | Left atrial appendage closure with WATCHMAN in Asian patients: 2 year outcomes from the WASP registry |
| title_fullStr | Left atrial appendage closure with WATCHMAN in Asian patients: 2 year outcomes from the WASP registry |
| title_full_unstemmed | Left atrial appendage closure with WATCHMAN in Asian patients: 2 year outcomes from the WASP registry |
| title_short | Left atrial appendage closure with WATCHMAN in Asian patients: 2 year outcomes from the WASP registry |
| title_sort | left atrial appendage closure with watchman in asian patients 2 year outcomes from the wasp registry |
| url | http://www.sciencedirect.com/science/article/pii/S2352906719300272 |
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