Impact of CHA₂DS₂-VASc Score in the Outcomes of Patients Undergoing a Simplified Pathway for Percutaneous Left Atrial Appendage Closure.

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions Pub Date : 2025-05-20 DOI:10.1002/ccd.31613

Claudio Sanfilippo, Marco Frazzetto, Giuliano Costa, Claudia Contrafatto, Chiara Giacalone, Francesco Briguglio, Chiara Barbera, Jessica De Santis, Maria Sanfilippo, Giuseppe Castania, Maria Elena Di Salvo, Salvatore Scandura, Guilherme Attizzani, Steven Filby, Corrado Tamburino, Marco Barbanti, Carmelo Grasso, Davide Capodanno

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引用次数: 0

Abstract

Background: Percutaneous left atrial appendage closure (LAAC) is usually performed after a pre-procedural evaluation by transesophageal echocardiography (TOE) or cardiac computed tomography angiography (CCTA). Nevertheless, these ad-hoc examinations imply an additional use of hospital resources and time spending.

Aims: To investigate long-term clinical outcomes, effectiveness and safety of performing LAAC procedures without pre-procedural imaging assessment in patients with high and very high thromboembolic risk based on CHA₂DS₂-VASc score.

Methods: From January 2016 to January 2023, 227 consecutive patients undergoing LAAC following an optimized pathway that removed the use of pre-procedural TOE or CCTA imaging assessment, were enrolled in this single-center, retrospective study. Patients were divided into two groups based on thromboembolic risk: 94 had CHA₂DS₂-VASc scores ≥ 5 and 133 had CHA₂DS₂-VASc scores < 5). The primary endpoint was a composite of all-cause death, stroke, systemic embolization, or bleeding events at 2 years. Co-primary endpoints were device success, device-related thrombosis (DRT) and peri-device leaks (PDL) ≥ 3 mm at TOE follow-up.

Results: At 2 years, no significant differences were observed between groups in the primary composite endpoint (KM est. 24.81% vs. 20.21%, p_log-rank = 0.7; aHR 0.85, CI: 0.48-1.50, p = 0.58). Device success was 98.7% overall, with no significant differences between groups (aOR 0.32% CI: 0.03-3.80; p = 0.37). DRT and PDL ≥ 3 mm rates were low (4.3% vs. 1.5%, p = 0.26% and 3.2% vs. 2.3%, p = 0.75, respectively). In-hospital complications were low and comparable in both groups.

Conclusions: In a consecutive series of patients undergoing LAAC, a simplified approach without pre-operative imaging assessment showed comparable results at 2-year for the primary composite endpoint of all-cause death, stroke, systemic embolization, or bleeding events in patients with CHA₂DS₂-VASc score ≥ 5 and those with CHA₂DS₂-VASc score < 5.

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CHA2DS2-VASc评分对经皮左心耳简易封闭术患者预后的影响

背景：经食管超声心动图（TOE）或心脏计算机断层血管造影（CCTA）术前评估后，通常进行经皮左心耳闭合术（LAAC）。然而，这些临时检查意味着额外使用医院资源和花费时间。目的：探讨基于CHA2DS2-VASc评分的高和极高血栓栓塞风险患者在不进行术前影像学评估的情况下进行LAAC手术的长期临床结果、有效性和安全性。方法：从2016年1月至2023年1月，连续227例患者接受LAAC手术，经过优化的路径，取消了术前TOE或CCTA成像评估，纳入了这项单中心回顾性研究。根据血栓栓塞风险将患者分为两组：94例患者CHA2DS2-VASc评分≥5,133例患者CHA2DS2-VASc评分≥5。结果：2年时，两组在主要综合终点(KM检验：24.81% vs. 20.21%, plog-rank = 0.7；aHR 0.85, CI: 0.48 ~ 1.50, p = 0.58)。器械成功率为98.7%，两组间无显著差异(aOR 0.32% CI: 0.03-3.80；p = 0.37)。DRT和PDL≥3mm率较低（分别为4.3%对1.5%,p = 0.26%和3.2%对2.3%,p = 0.75）。两组住院并发症发生率低且具有可比性。结论：在连续一系列接受LAAC的患者中，未经术前影像学评估的简化方法显示，在CHA2DS2-VASc评分≥5的患者和CHA2DS2-VASc评分的患者中，2年的主要复合终点全因死亡、卒中、全身性栓塞或出血事件的结果相当

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.