DOAC评分预测左心耳关闭后临床结果

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-04-01 DOI:10.1016/j.cjco.2025.01.009

Masahiko Asami MD , Yu Horiuchi MD , Jun Tanaka MD , Daiki Yoshiura MD , Masanori Taniwaki MD , Kota Komiyama MD, PhD , Hitomi Yuzawa MD, PhD , Kengo Tanabe MD, PhD , Mitsuru Sago CE , Shuhei Tanaka MD, PhD , Ryuki Chatani MD , Toru Naganuma MD , Yohei Ohno MD, PhD , Tomoyuki Tani MD , Hideharu Okamatsu MD , Kazuki Mizutani MD, PhD , Yusuke Watanabe MD, PhD , Masaki Izumo MD, PhD , Mike Saji MD, PhD , Shingo Mizuno MD , Kentaro Hayashida MD, PhD

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引用次数: 0

摘要

直接作用口服抗凝剂（DOAC）评分已被证实可用于评估心房颤动（AF）患者的出血风险。然而，经皮左心耳闭合术（LAAC）患者的DOAC评分数据有限。本研究旨在评估DOAC评分对LAAC后临床事件的预测作用，并将其与HAS-BLED评分（高血压、肾功能和肝功能异常、卒中、出血史或易感、不稳定国际标准化比率[INR]、老年人[年龄≥65岁]、药物和酒精合并）评分进行比较。方法在这项前瞻性、多中心、观察性研究中，根据DOAC评分将接受LAAC治疗的非瓣膜性房颤（NVAF）患者分为高（HBR）和低出血风险组。在3个月和1年时评估全因死亡、中风和出血的主要终点。结果1464例患者中，平均年龄77.1岁；67.6%男性)，HBR组（923例患者）的体重指数较低，合并症更频繁，出血和中风的风险更高。两组间的器械、技术和手术成功率高且相似。1年时，HBR组的主要终点较高（17.6% vs 12.4%, P = 0.01），受出血事件差异的影响（10.9% vs 7.6%, P = 0.045）。与ha - bled评分相比，DOAC评分对主要终点的预测价值更高。结论：DOAC评分是LAAC患者综合预后（包括死亡、卒中和出血）的可靠预测指标，与ha - bled评分相比具有更高的实用性。该评分系统可改善日常临床实践中的风险分层和患者管理。临床试验注册编号：UMIN000038498 （OCEAN-LAAC注册）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

DOAC Score for Predicting Clinical Outcomes After Left Atrial Appendage Closure

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DOAC Score for Predicting Clinical Outcomes After Left Atrial Appendage Closure

Background

The direct-acting oral anticoagulant (DOAC) score has been validated for assessing the bleeding risk in patients with atrial fibrillation (AF). However, data on DOAC scores in patients undergoing percutaneous left atrial appendage closure (LAAC) is limited. This study aimed to evaluate the predictive impact of the DOAC score on clinical events following LAAC and compare it with that of the HAS-BLED (Hypertension, Abnormal renal and liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio [INR], Elderly [age ≥65 years], Drugs and alcohol concomitantly) score.

Methods

In this prospective, multicenter, observational study, patients with nonvalvular AF (NVAF) undergoing LAAC were categorized by the DOAC score into higher (HBR) and lower bleeding risk groups. The primary endpoints of all-cause death, stroke, and bleeding were evaluated at 3 months and 1 year.

Results

Among 1464 patients (mean age 77.1 years; 67.6% male), the HBR group (923 patients) had a lower body mass index, more frequent comorbidities, and higher risk profiles for bleeding and stroke. The device, technical, and procedural success rates were high and similar between groups. At 1 year, the primary endpoint was higher in the HBR group (17.6% vs 12.4%, P = 0.01), influenced by differences in bleeding events (10.9% vs 7.6%, P = 0.045). The DOAC score showed superior predictive value for the primary endpoint compared with the HAS-BLED score.

Conclusions

The DOAC score is a reliable predictor of composite outcomes, including death, stroke, and bleeding, in patients undergoing LAAC, demonstrating superior utility compared with the HAS-BLED score. This scoring system may improve risk stratification and patient management in daily clinical practice.