Korean Circ J.  2021 Jul;51(7):626-638. 10.4070/kcj.2020.0527.

Percutaneous Left Atrial Appendage Occlusion Yields Favorable Neurological Outcomes in Patients with Non-Valvular Atrial Fibrillation

• Lee OH
• Kim YD
• Kim JS
• Son NH
• Pak HN
• Joung B
• Yu CW
• Lee HJ
• Kang WC
• Shin ES
• Choi Rk
• Lim DS
• Jung YH
• Choi HY
• Lee KY
• Cho BH
• Han SW
• Park JH
• Cho HJ
• Park HJ
• Nam HS
• Heo JH
• So Cy
• Cheung GSH
• Lam Yy
• Freixa X
• Tzikas A
• Jang Y
• Park JW

• KMID: 2517492
• DOI: http://doi.org/10.4070/kcj.2020.0527

Abstract

Background and Objectives
Prior studies have shown that stroke patients treated with percutaneous left atrial appendage occlusion (LAAO) for non-valvular atrial fibrillation (NVAF) experience better outcomes than similar patients treated with warfarin. We investigated the impact of percutaneous left atrial appendage closure on post-stroke neurological outcomes in NVAF patients, compared with non-vitamin K antagonist oral anticoagulant (NOAC) therapy.
Methods
Medical records for 1,427 patients in multiple registries and for 1,792 consecutive patients at 6 Korean hospitals were reviewed with respect to LAAO or NOAC treatment. Stroke severity in patients who experienced ischemic stroke or transient ischemic attack after either treatment was assessed with modified Rankin Scale (mRS) scoring at hospital discharge and at 3 and 12 months post-stroke.
Results
mRS scores were significantly lower in LAAO patients at 3 (p<0.01) and 12 months (p<0.01) post-stroke, despite no significant differences in scores before the ischemic cerebrovascular event (p=0.22). The occurrences of disabling ischemic stroke in the LAAO and NOAC groups were 36.7% and 44.2% at discharge (p=0.47), 23.3% and 44.2% at 3 months post-stroke (p=0.04), and 13.3% and 43.0% at 12 months post-stroke (p=0.01), respectively. Recovery rates for disabling ischemic stroke at discharge to 12 months post-stroke were significantly higher for LAAO patients (50.0%) than for NOAC patients (5.6%) (p<0.01).
Conclusions
Percutaneous LAAO was associated with more favorable neurological outcomes after ischemic cerebrovascular event than NOAC treatment.

Keyword

Stroke; Atrial fibrillation; Atrial appendage; Factor Xa inhibitors

Figure

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  Figure 1 Overview of study participants and corresponding ischemic events.ACP = Amplatzer cardiac plug; AF = atrial fibrillation; LAAO = left atrial appendage occlusion.*Ischemic stroke or transient ischemic attack.

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  Figure 2 Comparison of stroke severity in patients treated with LAAO or NOACs. Changes in modified Rankin Scale scores of patients from each treatment group at the time of hospital discharge and at the 12-month follow-up visit are shown.LAAO = left atrial appendage occlusion; NOAC = non-vitamin K antagonist oral anticoagulant.

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  Figure 3 Stroke burden reduction with percutaneous LAAO vs. NOAC treatment.LAAO = left atrial appendage occlusion; NOAC = non-vitamin K antagonist oral anticoagulant.

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