{"title":"有缺血性脑卒中史的患者口服抗凝血后左心耳关闭。","authors":"Tadatomo Fukushima, Masato Fukunaga, Akihiro Isotani, Miho Nakamura, Kenichi Ishizu, Shinichi Shirai, Masahiko Asami, Mitsuru Sago, Shuhei Tanaka, Ryuki Chatani, Daisuke Hachinohe, Toru Naganuma, Yohei Ohno, Tomoyuki Tani, Hideharu Okamatsu, Yusuke Watanabe, Masaki Izumo, Mike Saji, Shingo Mizuno, Hiroshi Ueno, Shunsuke Kubo, Masaki Nakashima, Masanori Yamamoto, Kenji Ando, Kentaro Hayashida","doi":"10.1016/j.jacep.2025.07.021","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Patients who have an ischemic stroke (IS) with an oral anticoagulant (OAC) have a high recurrence rate of IS. There is insufficient data on left atrial appendage closure (LAAC) for patients with nonvalvular atrial fibrillation (AF) who have had an IS despite OAC.</p><p><strong>Objectives: </strong>The objectives of this study were to compare the clinical outcomes of the patients after LAAC based on IS risk.</p><p><strong>Methods: </strong>This study was retrospective observational study from the OCEAN-LAAC (Optimized Catheter Valvular Intervention-Left Atrial Appendage Closure) registry. Nonvalvular AF patients who underwent LAAC were divided into 3 groups: a control group with no IS history, a group having a previous IS despite an OAC, and a group having a previous IS without OAC. The coprimary endpoints were cardiovascular (CV) death and IS.</p><p><strong>Results: </strong>We included 1,418 patients (median CHA<sub>2</sub>DS<sub>2</sub>-VASc 5.0, HAS-BLED 3.0) undergoing LAAC. The previous history of IS was noted in 503 (35.4%), and 346 patients were under an OAC. During the median follow-up period of 367 days, no differences in CV death rate were observed among the 3 groups (previous IS despite OAC, subdistribution HR [sHR]: 1.78; 95% CI: 0.87-3.64; previous IS without OAC, sHR: 1.45; 95% CI: 0.59-3.55). The incidence of IS after LAAC was predominantly higher in the previous IS despite OAC group (sHR: 2.62; 95% CI: 1.17-5.86; Gray's test: P = 0.02; previous IS without OAC: sHR: 1.24; 95% CI: 0.36-4.28; Gray's test: P = 0.70).</p><p><strong>Conclusions: </strong>The patients after LAAC who have had an IS despite OAC did not differ in CV death but were at higher risk of IS even after LAAC.</p>","PeriodicalId":14573,"journal":{"name":"JACC. Clinical electrophysiology","volume":" ","pages":""},"PeriodicalIF":7.7000,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Left Atrial Appendage Closure for Patients With a History of Ischemic Stroke Despite Oral Anticoagulant.\",\"authors\":\"Tadatomo Fukushima, Masato Fukunaga, Akihiro Isotani, Miho Nakamura, Kenichi Ishizu, Shinichi Shirai, Masahiko Asami, Mitsuru Sago, Shuhei Tanaka, Ryuki Chatani, Daisuke Hachinohe, Toru Naganuma, Yohei Ohno, Tomoyuki Tani, Hideharu Okamatsu, Yusuke Watanabe, Masaki Izumo, Mike Saji, Shingo Mizuno, Hiroshi Ueno, Shunsuke Kubo, Masaki Nakashima, Masanori Yamamoto, Kenji Ando, Kentaro Hayashida\",\"doi\":\"10.1016/j.jacep.2025.07.021\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Patients who have an ischemic stroke (IS) with an oral anticoagulant (OAC) have a high recurrence rate of IS. There is insufficient data on left atrial appendage closure (LAAC) for patients with nonvalvular atrial fibrillation (AF) who have had an IS despite OAC.</p><p><strong>Objectives: </strong>The objectives of this study were to compare the clinical outcomes of the patients after LAAC based on IS risk.</p><p><strong>Methods: </strong>This study was retrospective observational study from the OCEAN-LAAC (Optimized Catheter Valvular Intervention-Left Atrial Appendage Closure) registry. Nonvalvular AF patients who underwent LAAC were divided into 3 groups: a control group with no IS history, a group having a previous IS despite an OAC, and a group having a previous IS without OAC. The coprimary endpoints were cardiovascular (CV) death and IS.</p><p><strong>Results: </strong>We included 1,418 patients (median CHA<sub>2</sub>DS<sub>2</sub>-VASc 5.0, HAS-BLED 3.0) undergoing LAAC. The previous history of IS was noted in 503 (35.4%), and 346 patients were under an OAC. During the median follow-up period of 367 days, no differences in CV death rate were observed among the 3 groups (previous IS despite OAC, subdistribution HR [sHR]: 1.78; 95% CI: 0.87-3.64; previous IS without OAC, sHR: 1.45; 95% CI: 0.59-3.55). The incidence of IS after LAAC was predominantly higher in the previous IS despite OAC group (sHR: 2.62; 95% CI: 1.17-5.86; Gray's test: P = 0.02; previous IS without OAC: sHR: 1.24; 95% CI: 0.36-4.28; Gray's test: P = 0.70).</p><p><strong>Conclusions: </strong>The patients after LAAC who have had an IS despite OAC did not differ in CV death but were at higher risk of IS even after LAAC.</p>\",\"PeriodicalId\":14573,\"journal\":{\"name\":\"JACC. Clinical electrophysiology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":7.7000,\"publicationDate\":\"2025-09-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JACC. Clinical electrophysiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jacep.2025.07.021\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JACC. Clinical electrophysiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jacep.2025.07.021","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Left Atrial Appendage Closure for Patients With a History of Ischemic Stroke Despite Oral Anticoagulant.
Background: Patients who have an ischemic stroke (IS) with an oral anticoagulant (OAC) have a high recurrence rate of IS. There is insufficient data on left atrial appendage closure (LAAC) for patients with nonvalvular atrial fibrillation (AF) who have had an IS despite OAC.
Objectives: The objectives of this study were to compare the clinical outcomes of the patients after LAAC based on IS risk.
Methods: This study was retrospective observational study from the OCEAN-LAAC (Optimized Catheter Valvular Intervention-Left Atrial Appendage Closure) registry. Nonvalvular AF patients who underwent LAAC were divided into 3 groups: a control group with no IS history, a group having a previous IS despite an OAC, and a group having a previous IS without OAC. The coprimary endpoints were cardiovascular (CV) death and IS.
Results: We included 1,418 patients (median CHA2DS2-VASc 5.0, HAS-BLED 3.0) undergoing LAAC. The previous history of IS was noted in 503 (35.4%), and 346 patients were under an OAC. During the median follow-up period of 367 days, no differences in CV death rate were observed among the 3 groups (previous IS despite OAC, subdistribution HR [sHR]: 1.78; 95% CI: 0.87-3.64; previous IS without OAC, sHR: 1.45; 95% CI: 0.59-3.55). The incidence of IS after LAAC was predominantly higher in the previous IS despite OAC group (sHR: 2.62; 95% CI: 1.17-5.86; Gray's test: P = 0.02; previous IS without OAC: sHR: 1.24; 95% CI: 0.36-4.28; Gray's test: P = 0.70).
Conclusions: The patients after LAAC who have had an IS despite OAC did not differ in CV death but were at higher risk of IS even after LAAC.
期刊介绍：
JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.
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