Left atrial appendage closure in patients with chronic kidney disease: results from the German multicentre LAARGE registry

Language
en
Document Type
Article
Issue Date
2023-05-22
First published
2021-01-01
Issue Year
2021
Authors
Fastner, Christian
Brachmann, Johannes
Lewalter, Thorsten
Zeymer, Uwe
Sievert, Horst
Borggrefe, Martin
Nienaber, Christoph A.
Weiß, Christian
Pleger, Sven T.
Ince, Hüseyin
Editor
Publisher
Springer Berlin Heidelberg
Abstract

Abstract

      Objectives
      Chronic kidney disease (CKD) is associated with an increased complication rate after cardiac interventions. Although CKD has a high prevalence among atrial fibrillation patients, the impact of CKD on periprocedural complications and the outcome after an interventional left atrial appendage closure (LAAC) is unclear. The present study, therefore, aimed to investigate whether CKD influences the procedure’s effectiveness and safety.
    
    
      Methods
      LAARGE is a prospective, non-randomised registry. LAAC was conducted with different standard commercial devices, and the follow-up period was one year. CKD was defined by an eGFR < 60 mL/min/1.73 m2, and subgroups were further analysed (i.e. eGFR < 15, 15–29, and 30–59 mL/min/1.73 m2, respectively).
    
    
      Results
      Two hundred ninety-nine of 623 patients (48.0%) revealed a CKD. The prevalence of cardiovascular comorbidity, CHA2DS2-VASc score (4.9 vs. 4.2), and HAS-BLED score (4.3 vs. 3.5) was significantly higher in CKD patients (each p < 0.001). Implantation success was similarly high across all GFR groups (97.9%). Periprocedural MACCE (0.7 vs. 0.3%), and other major complications (4.7 vs. 3.7%) were comparably infrequent. Survival free of stroke was significantly lower among CKD patients within 1 year (82.0 vs. 93.0%; p < 0.001; consistent after adjustment for confounding factors), without significant accentuation in advanced CKD (i.e. eGFR < 30 mL/min/1.73 m2; p > 0.05  vs. eGFR 30–59 mL/min/1.73 m2). Non-fatal strokes were absolutely infrequent during follow-up (0 vs. 1.1%). Severe non-fatal bleedings were observed only among CKD patients (1.4 vs. 0%; p = 0.021).
    
    
      Conclusions
      Despite an increased cardiovascular risk profile of CKD patients, device implantation was safe, and LAAC was associated with effective stroke prevention across all CKD stages.
Journal Title
Clinical Research in Cardiology
Volume
110
Issue
1
Citation
Clinical Research in Cardiology 110.1 (2021): 12-20. <https://link.springer.com/article/10.1007/s00392-020-01638-5>
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