左心房阑尾闭塞术患者的医生认证与疗效之间的关系

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2025-03-10 DOI:10.1016/j.jcin.2024.10.020

Amit N. Vora MD, MPH , Lucy A. Pereira BA , Chengan Du PhD , Zhen Tan MS , Chien Yu Huang PhD , Daniel J. Friedman MD , Yongfei Wang MS , Kamil F. Faridi MD, MSc , Dhanunjaya R. Lakkireddy MD , Sarah Zimmerman MS , Angela Y. Higgins MD , Samir R. Kapadia MD , Jeptha P. Curtis MD , James V. Freeman MD, MPH, MS

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引用次数: 0

摘要

背景：经皮左心房阑尾封堵术（LAAO）适用于禁忌长期口服抗凝药的心房颤动患者。介入心脏病学（IC）与电生理学（EP）]操作者认证的结果是否不同尚不清楚：比较 NCDR LAAO 注册中不同医师认证（EP 与 IC）的 LAAO 结果：我们确定了 2020-2022 年期间接受 Watchman FLX 或 Amulet LAAO 装置植入的患者，并根据主要操作者认证对患者进行了分层。相关结果包括(1) 任何重大不良事件 (MAE)；2) 死亡率；3) 缺血性中风；4) 首次住院期间和 45 天内的大出血。我们进行了多变量考克斯比例危险回归分析，以确定不同医生认证的不良事件风险：在研究期间，共有 1638 名医生（57% 为电生理学家）实施了 91,711 例手术。多变量回归后，电生理学家更有可能使用心内超声心动图（25.2% vs 9.7%，pdeath 1.03，95% CI (0.89-1.2)]或 MAE [HRMAE 0.97，95% CI (0.91-1.03)]：结论：当代 LAAO 是安全的，手术并发症发生率低，经多变量调整后，手术结果与操作者的亚专科无明显差异。为了让符合条件的患者能够广泛接受这种治疗，EP 和 IC 有必要继续利用该技术。

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Association of Physician Certification and Outcomes Among Patients Undergoing Left Atrial Appendage Occlusion

Background

Percutaneous left atrial appendage occlusion (LAAO) is indicated in patients with atrial fibrillation for whom long-term oral anticoagulation is contraindicated. Whether outcomes are different based on operator certification (interventional cardiology [IC] vs electrophysiology [EP]) is unclear.

Objectives

The authors sought to compare LAAO outcomes by physician certification (EP vs IC) in the NCDR (National Cardiovascular Data Registry) LAAO Registry.

Methods

We identified patients from 2020 to 2022 undergoing implantation of a Watchman FLX (Boston Scientific) or Amulet (Abbott Cardiovascular) LAAO device and stratified patients by primary operator certification. Outcomes of interest included: 1) any major adverse event (MAE); 2) mortality; 3) ischemic stroke; and 4) major bleeding during the initial hospitalization and at 45 days. We performed multivariable Cox proportional hazards regression analysis to determine the risk of adverse events by physician certification.

Results

A total of 1,638 physicians (57% electrophysiologists) performing 91,711 procedures during the study period were included. EPs were more likely to use intracardiac echocardiography (25.2% vs 9.7%; P < 0.001) and had lower radiation total (235 mGy vs 305 mGy; P < 0.001). EPs were more likely than ICs to discharge patients on DOAC + aspirin, whereas ICs were more likely to discharge patients on single or dual antiplatelet therapy (all P < 0.001). In-hospital death (0.1% vs 0.1%; P = 0.46) and MAE (1.5% vs 1.6%; P = 0.42) were similar by physician certification. At 45 days, there was no difference in death (HR_death: 1.03; 95% CI: 0.89-1.20) or MAE (HR_MAE: 0.97; 95% CI: 0.91-1.03) after multivariable regression.

Conclusions

Contemporary LAAO is safe with low rates of procedural complications and no significant differences in procedural outcomes by operator subspecialty after multivariable adjustment. Continued utilization of technology by EPs and ICs is necessary to allow for broad access to this treatment for eligible patients.

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来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.