Incidence and predictors of 2-year mortality following percutaneous left atrial appendage occlusion in the EWOLUTION trial.

IF 7.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Europace Pub Date : 2024-07-02 DOI:10.1093/europace/euae188

Errol W Aarnink, Hueseyin Ince, Stephan Kische, Evgeny Pokushalov, Thomas Schmitz, Boris Schmidt, Tommaso Gori, Felix Meincke, Alexey Vladimir Protopopov, Timothy Betts, Patrizio Mazzone, Marek Grygier, Horst Sievert, Tom De Potter, Elisa Vireca, Kenneth Stein, Martin W Bergmann, Lucas V A Boersma

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Abstract

Aims: Sufficient survival time following left atrial appendage occlusion (LAAO) is essential for ensuring the efficacy and cost-effectiveness of this strategy for stroke prevention. Understanding prognostic factors for early mortality after LAAO could optimize patient selection. In the current study, we perform an in-depth analysis of 2-year mortality after LAAO, focusing particularly on potential predictors.

Methods and results: The EWOLUTION registry is a real-world cohort comprising 1020 patients that underwent LAAO. Endpoint definitions were pre-specified, and death was categorized as cardiovascular, non-cardiovascular, or unknown origin. Mortality rates were calculated from Kaplan-Meier estimates. Baseline characteristics significantly associated with death in univariate Cox regression analysis were incorporated into the multivariate analysis. All multivariate predictors were included in a risk model. Two-year mortality rate was 16.4% [confidence interval (CI): 14.0-18.7%], with 50% of patients dying from a non-cardiovascular cause. Multivariate baseline predictors of 2-year mortality included age [hazard ratio (HR) 1.05, CI: 1.03-1.08, per year increase], heart failure (HR 1.73, CI: 1.24-2.41), vascular disease (HR 1.47, CI: 1.05-2.05), valvular disease (HR 1.63, CI: 1.15-2.33), abnormal liver function (HR 1.80, CI: 1.02-3.17), and abnormal renal function (HR 1.58, CI: 1.10-2.27). Mortality rate exhibited a gradual rise as the number of risk factors increased, reaching 46.1% in patients presenting with five or six risk factors.

Conclusion: One in six patients died within 2 years after LAAO. We identified six independent predictors of mortality. When combined, this model showed a gradual increase in mortality rate with a growing number of risk factors, which may guide appropriate patient selection for LAAO.

Clinical trial registration: The original EWOLUTION registry was registered at clinicaltrials.gov under identifier NCT01972282.

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EWOLUTION 试验中经皮左心房阑尾闭塞术后 2 年死亡率的发生率和预测因素。

目的：左心房阑尾闭塞术（LAAO）后充足的存活时间对于确保这一预防中风策略的有效性和成本效益至关重要。了解 LAAO 后早期死亡率的预后因素可优化患者选择。在本研究中，我们对 LAAO 术后 2 年的死亡率进行了深入分析，尤其关注潜在的预测因素：EWOLUTION 登记是一个真实世界的队列，由 1020 名接受 LAAO 的患者组成。终点定义是预先确定的，死亡分为心血管死亡、非心血管死亡或原因不明死亡。死亡率根据 Kaplan-Meier 估计值计算。在单变量 Cox 回归分析中与死亡明显相关的基线特征被纳入多变量分析。所有多变量预测因素均纳入风险模型。两年死亡率为16.4%[置信区间（CI）：14.0-18.7%]，其中50%的患者死于非心血管疾病。两年死亡率的多变量基线预测因素包括年龄[危险比（HR）1.05，CI：1.03-1.08，每增加一年]、心力衰竭（HR 1.73，CI：1.24-2.41）、血管疾病（HR 1.47，CI：1.05-2.05）、瓣膜疾病（HR 1.63，CI：1.15-2.33）、肝功能异常（HR 1.80，CI：1.02-3.17）和肾功能异常（HR 1.58，CI：1.10-2.27）。死亡率随着危险因素的增加而逐渐上升，在有五或六个危险因素的患者中，死亡率达到了46.1%：结论：每六名患者中就有一人在LAAO术后两年内死亡。我们发现了六个独立的死亡率预测因素。综合来看，该模型显示死亡率随着风险因素的增加而逐渐升高，这可以为选择合适的 LAAO 患者提供指导：最初的EWOLUTION注册登记在clinicaltrials.gov上，标识符为NCT01972282。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Europace 医学-心血管系统

CiteScore

10.30

自引率

8.20%

发文量

851

审稿时长

3-6 weeks

期刊介绍： EP - Europace - European Journal of Pacing, Arrhythmias and Cardiac Electrophysiology of the European Heart Rhythm Association of the European Society of Cardiology. The journal aims to provide an avenue of communication of top quality European and international original scientific work and reviews in the fields of Arrhythmias, Pacing and Cellular Electrophysiology. The Journal offers the reader a collection of contemporary original peer-reviewed papers, invited papers and editorial comments together with book reviews and correspondence.