慢性肾病和终末期肾病患者植入左房阑尾闭塞器的不良后果:系统回顾和荟萃分析。

IF 1.6 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular Revascularization Medicine Pub Date : 2024-08-22 DOI:10.1016/j.carrev.2024.08.016
Gauravpal S Gill, Shikha Shailly, Teja Chakrala, Anirudh Palicherla, Pramod K Ponna, Venkata Mahesh Alla, Arun Kanmanthareddy
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引用次数: 0

摘要

背景:慢性肾脏病(CKD)和终末期肾病(ESRD)与正在接受抗凝治疗的心房颤动患者发生出血事件(包括出血性中风)、围手术期出血和消化道出血的风险增加有关。经皮左心房阑尾封堵术(LAAO)在这类患者中的安全性尚不确定,研究结果相互矛盾:方法:我们在 PubMed 和 Google Scholar 数据库中查询了对接受 LAAO 装置植入术的慢性肾脏病患者与非慢性肾脏病患者、ESRD 患者与非 ESRD 患者的疗效进行比较的研究。从所选研究中提取结果数据,并使用随机效应模型进行分析。使用I2检验评估异质性:最终分析纳入了来自11项研究、61 724名肾病和非肾病患者的数据。院内死亡风险增加(OR 2.76,95 % CI [1.15-6.64];P = 0.02),围手术期出血风险增加(1.51 [1.33-1.71];P 结论:本研究显示,肾病患者接受 LAAO 装置植入术后并发症风险增加。这些研究结果表明,有必要进行随机对照研究,专门比较肾脏疾病和 ESRD 患者接受 LAAO 与抗凝治疗的结果。
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Adverse outcomes with left atrial appendage occlusion device implantation in chronic and end stage kidney disease: A systemic review and meta-analysis.

Background: Chronic kidney disease (CKD) and end stage renal disease (ESRD) are associated with increased risk of bleeding events, including hemorrhagic stroke, and periprocedural and gastrointestinal bleeding among patients with atrial fibrillation who are on anticoagulation. Safety of percutaneous left atrial appendage occlusion (LAAO) among this patient population has been uncertain with studies showing contradictory results.

Methods: PubMed and Google Scholar databases were queried for studies comparing outcomes among patients with and without significant CKD, and with and without ESRD who underwent LAAO device implantation. Data on outcomes from the selected studies were extracted and analyzed using random effects model. Heterogeneity was assessed using I2 test.

Results: Data from eleven studies with 61,724 patients with and without kidney disease were included in the final analyses. There was an increased risk of in-hospital mortality (OR 2.76, 95 % CI [1.15-6.64]; p = 0.02) and peri-procedural bleeding (1.51 [1.33-1.71]; p < 0.01) associated with kidney disease. There was no significant difference in risk of stroke (1.19 [0.70-2.03]; p = 0.53), pericardial effusion (1.22 [0.77-1.92]; p = 0.40), vascular complications (1.18 [0.92-1.52]; p = 0.20), or device related thrombus (1.13 [0.53-2.40]; p = 0.75).

Conclusions: This study shows an increased risk of complications among patients with kidney disease, who undergo LAAO device implantation. These findings suggest the need for studies with randomized control design specifically designed to compare outcomes with LAAO versus anticoagulation in the CKD and ESRD populations.

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来源期刊
Cardiovascular Revascularization Medicine
Cardiovascular Revascularization Medicine CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.30
自引率
5.90%
发文量
687
审稿时长
36 days
期刊介绍: Cardiovascular Revascularization Medicine (CRM) is an international and multidisciplinary journal that publishes original laboratory and clinical investigations related to revascularization therapies in cardiovascular medicine. Cardiovascular Revascularization Medicine publishes articles related to preclinical work and molecular interventions, including angiogenesis, cell therapy, pharmacological interventions, restenosis management, and prevention, including experiments conducted in human subjects, in laboratory animals, and in vitro. Specific areas of interest include percutaneous angioplasty in coronary and peripheral arteries, intervention in structural heart disease, cardiovascular surgery, etc.
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