Prasana Ramesh, Uneza Khawaja, Chidubem Ezenna, Sudhi Reddy, Marshal Fox, Alexander Knee, Amin Daoulah, Hafiz Imran, Mohammad Kashef, Andrew M Goldsweig, Amir Lotfi
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引用次数: 0
Abstract
Background: Patients with nonvalvular atrial fibrillation with contraindication to anticoagulation undergo Left Atrial Appendage Closure. SCAI/HRS consensus recommends routine post-procedure TTE before same-day discharge. We studied whether there was a difference in outcomes with and without a TTE after device implantation by measuring 45-day hospitalization for any reason.
Methods: We performed a retrospective observational study using the data from our institutional LAAC registry. We compared patients discharged on the same day after the procedure who underwent a TTE vs patients who were discharged without a TTE. The Primary outcome studied was 45-day readmission for any given reason from the day of discharge.
Results: In a Cohort of patients who were discharged on the same day, 350 did not undergo post-procedure TTE, and 60 underwent TTE. 33 patients were readmitted in the TTE group, and 4 patients were readmitted in the No TTE group. The RR for readmission without vs. with pre-discharge TTE was 1.41 (95 % CI 0.52-3.85, p = 0.25). No 45-day mortality occurred in either study group.
Conclusion: For patients undergoing LAAC with same-day discharge, routine TTE before discharge did not significantly influence 45-day readmission rates. Given the absence of clinical benefit but the presence of TTE costs and resource use, a more selective approach to post-procedural imaging should be considered.
背景:有抗凝禁忌的非瓣膜性心房颤动患者行左心房附件关闭术。SCAI/HRS一致建议在当天出院前进行常规术后TTE检查。我们通过测量因任何原因住院45天的情况来研究装置植入后有无TTE的结果差异。方法:我们使用我们机构LAAC登记的数据进行回顾性观察研究。我们比较了手术后同一天出院接受TTE治疗的患者与未接受TTE治疗的患者。研究的主要结局是从出院之日起45天内因任何特定原因再入院。结果:在同一天出院的患者队列中,350例未进行术后TTE治疗,60例进行了TTE治疗。有TTE组33例再入院,无TTE组4例再入院。无出院前TTE的再入院RR为1.41 (95% CI 0.52-3.85, p = 0.25)。两组均未发生45天死亡率。结论:对于当日出院的LAAC患者,出院前常规TTE对45天再入院率无显著影响。鉴于没有临床益处,但存在TTE成本和资源使用,应考虑更有选择性的术后影像学方法。
期刊介绍:
Cardiovascular Revascularization Medicine (CRM) is an international and multidisciplinary journal that publishes original laboratory and clinical investigations related to revascularization therapies in cardiovascular medicine. Cardiovascular Revascularization Medicine publishes articles related to preclinical work and molecular interventions, including angiogenesis, cell therapy, pharmacological interventions, restenosis management, and prevention, including experiments conducted in human subjects, in laboratory animals, and in vitro. Specific areas of interest include percutaneous angioplasty in coronary and peripheral arteries, intervention in structural heart disease, cardiovascular surgery, etc.