title: Impact of chronic kidney disease on left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation.
abstract: BACKGROUND
  Left atrial appendage occlusion (LAAO) using the Amplatzer cardiac plug (ACP) is a preventive treatment of atrial fibrillation related thromboembolism.
  
  
  OBJECTIVE
  To assess the safety and efficacy of LAAO in patients with chronic kidney disease (CKD).
  
  
  METHODS
  Among the ACP multicentre registry, 1014 patients (75±8yrs) with available renal function were included.
  
  
  RESULTS
  Patients with CKD (N=375, CHA2DS2-VASc: 4.9±1.5, HASBLED: 3.4±1.3) were at higher risk than patients without CKD (N=639, CHA2DS2-VASc: 4.2±1.6, HASBLED: 2.9±1.2; p<0.001 for both). Procedural (97%) and occlusion (99%) success were similarly high in all stages of CKD. Peri-procedural major adverse events (MAE) were observed in 5.1% of patients, 0.8% of death, with no difference between patients with and those without CKD (6.1 vs 4.5%, p=0.47). In patients with complete follow-up (1319 patients years), the annual stroke+transient ischaemic attack (TIA) rate was 2.3% and the observed bleeding rate was 2.1% (62 and 60% less than expected, similarly among patients with and those without CKD). Kaplan-Meier analysis showed a lower overall survival (84 vs 96% and 84 vs 93% at 1 and 2yrs. respectively; p<0.001) among patients with an eGFR <30ml/min/1.73m(2).
  
  
  CONCLUSIONS
  LAAO using the ACP has a similar procedural safety among CKD patients compared to patients with normal renal function. LAAO with ACP offers a dramatic reduction of stroke+TIA rate and of bleeding rate persistent in all stages of CKD, as compared to the expected annual risk.
authors.affiliation: Cliniques universitaires Saint-Luc, Brussels, Belgium. Electronic address: joelle.kefer@uclouvain.be.
authors.forename: Joelle
authors.initials: J
authors.lastname: Kefer
authors.affiliation: Interbalkan European Medical Center, Thessaloniki, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Tzikas
authors.affiliation: Hospital Clinic of University of Barcelona, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Freixa
authors.affiliation: University Hospital of bern, Bern, Switzerland.
authors.forename: Samera
authors.initials: S
authors.lastname: Shakir
authors.affiliation: CardioVascular Center Frankfurt, Frankfurt, Germany; Seattle Heart and Vascular, Seattle, WA, USA.
authors.forename: Sameer
authors.initials: S
authors.lastname: Gafoor
authors.affiliation: Aarhus University Hospital, Skejby, Denmark.
authors.forename: Jens Erik
authors.initials: JE
authors.lastname: Nielsen-Kudsk
authors.affiliation: Heart Hospital, Fondazione C.N.R. Regione Toscana, Massa, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Berti
authors.affiliation: Ospedale Careggi di Firenze, Florence, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Santoro
authors.affiliation: Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium.
authors.forename: Adel
authors.initials: A
authors.lastname: Aminian
authors.affiliation: University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Ulf
authors.initials: U
authors.lastname: Landmesser
authors.affiliation: University Hospital of bern, Bern, Switzerland; University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Nietlispach
authors.affiliation: Montreal Heart Institute, Montreal, Canada.
authors.forename: Reda
authors.initials: R
authors.lastname: Ibrahim
authors.affiliation: Ospedale Luigi Sacco, Milan, Italy.
authors.forename: Paolo Luciano
authors.initials: PL
authors.lastname: Danna
authors.affiliation: Jessaziekenhuis, Hasselt, Belgium.
authors.forename: Edouard
authors.initials: E
authors.lastname: Benit
authors.affiliation: UZ Leuven, Leuven, Belgium.
authors.forename: Werner
authors.initials: W
authors.lastname: Budts
authors.affiliation: AZ Delta Roeselare, Roeselare, Belgium.
authors.forename: Francis
authors.initials: F
authors.lastname: Stammen
authors.affiliation: OLV Ziekenhuis, Aalst, Belgium.
authors.forename: Tom
authors.initials: T
authors.lastname: De Potter
authors.affiliation: Universitätsmedizin Göttingen, Göttingen, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Tichelbäcker
authors.affiliation: University Hospital of bern, Bern, Switzerland.
authors.forename: Steffen
authors.initials: S
authors.lastname: Gloekler
authors.affiliation: Imperial College Healthcare NHS Trust, London, United Kingdom.
authors.forename: Prapa
authors.initials: P
authors.lastname: Kanagaratnam
authors.affiliation: Coimbra University Hospital Centre, Coimbra, Portugal.
authors.forename: Marco
authors.initials: M
authors.lastname: Costa
authors.affiliation: University Hospital of Salamanca, Salamanca, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Cruz-Gonzalez
authors.affiliation: CardioVascular Center Frankfurt, Frankfurt, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Sievert
authors.affiliation: Universitätsmedizin Göttingen, Göttingen, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schillinger
authors.affiliation: Asklepios Hospital Hamburg, Hamburg, Germany.
authors.forename: Jai-Wun
authors.initials: JW
authors.lastname: Park
authors.affiliation: University Hospital of bern, Bern, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.affiliation: University Hospital of Bonn, Bonn, Germany.
authors.forename: Heyder
authors.initials: H
authors.lastname: Omran
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000601:surgery*; D006470:Hemorrhage / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000601:surgery*; D055989:Septal Occluder Device; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome
keywords: Amplatzer cardiac plug; Bleeding; Left atrial appendage; Renal failure; Stroke