Incidence and Clinical Impact of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion A Meta-Analysis
Incidence and Clinical Impact of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion A Meta-Analysis
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DOI：
10.1016/j.jacep.2018.09.007
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发表时间：
2018-12-01
影响因子：
7
通讯作者：
Raybuck, Bryan
中科院分区：
文献类型：
--
作者：
Alkhouli, Mohamad;Busu, Tatiana;Raybuck, Bryan
本研究旨在评估预防措施左心耳封堵术（LAAO）后器械相关血栓（DRT）的发生率和临床影响。背景器械相关血栓是LAAO的已知并发症。方法对66篇随机对照研究和观察性研究进行Meta分析，计算DRT的合并发生率和合并缺血事件的合并优势比（OR）。DRT发生率为351/10，153（3.8%，范围0%~ 17%，I-2 = 56.8）。分别有42%、57%和1%的患者在365天内确诊。AMPLATZER（AMPLATZER，阿加医疗公司，Golden Valley，Minnesota）和WATCHMAN（WATCHMAN，Boston Scientific Corporation，马尔伯勒，马萨诸塞州）器械的DRT率无差异（3.6% vs. 3.1%，p = 0.24）。在荟萃回归分析中，年龄、性别、心力衰竭、糖尿病、CHA（2）DS（2）-VASc评分、既往卒中和LAAO后抗血栓治疗方案不能解释DRT发生率的异质性。比较有和无DRT患者结局的研究中缺血事件的汇总发生率（32项研究; n = 7，689）为13.2%（37/280例）DRT患者，3.8%（7，399人中的285人）（OR：5.27，95%置信区间[CI]：3.66至7.59; p < 0.001，I-2 = 0）。在一项包括随机试验和前瞻性多中心登记研究的敏感性分析中，DRT的发生率为3.7%，DRT仍然与较高的缺血事件发生率相关（13.5% vs.4.4%，OR：4.15，95% CI：2.77 ~ 6.22;结论：LAAO术后DRT并不常见（3.8%），但与缺血事件增加4- 5倍有关。需要进一步的研究来了解DRT的潜在机制和最佳的监测和管理。(c)2018年由美国心脏病学会基金会。
OBJECTIVES This study sought to assess the incidence and clinical impact of device related thrombus (DRT) following precautions left atrial appendage occlusion (LAAO).BACKGROUND Device-related thrombus is a known complication of LAAO. However, data on the incidence of DRT and its impact on outcomes are limited.METHODS The authors performed a meta-analysis of randomized and observational studies to calculate the pooled incidence of DRT and the pooled odds ratio (OR) of ischemic events in patients with DRT and those without DRT.RESULTS In the 66 included studies; the incidence of DRT was 351/10, 153 (3.8%, range 0% to 17%, I-2 = 56.8). The diagnosis was made in 365 days in 42%, 57%, and 1% of patients, respectively. There was no difference in DRT rates between the AMPLATZER (AMPLATZER, AGA Medical Corporation, Golden Valley, Minnesota) and WATCHMAN (WATCHMAN, Boston Scientific Corporation, Marlborough, Massachusetts) devices (3.6% vs. 3.1%, p = 0.24). In a meta-regression, age, gender, heart failure, diabetes, CHA(2)DS(2)-VASc score, previous stroke, and post-LAAO antithrombotic regimen did not explain the heterogeneity in the incidence of DRT. The pooled incidence of ischemic events in studies that compared outcomes of patients with and without DRT (32 studies; n = 7,689) was 13.2% (37 of 280) in patients with DRT and 3.8% (285 of 7,399) in those without DRT (OR: 5.27, 95% confidence interval [CI]: 3.66 to 7.59; p < 0.001, I-2 = 0). In a sensitivity analysis including randomized trials and prospective multicenter registries, the incidence of DRT was 3.7%, and DRT remained associated with higher rates of ischemic events (13.5% vs. 4.4%, OR: 4.15, 95% CI: 2.77 to 6.22; p < 0.001, I-2 = 0).CONCLUSIONS DRT after LAAO is uncommon (3.8%) but is associated with a 4- to 5-fold increase in ischemic events. Further studies are needed to understand the underlying mechanisms and the optimal surveillance and management of DRT. (c) 2018 by the American College of Cardiology Foundation.