Impact of Preprocedure Imaging for Left Atrial Appendage Occlusion: Insights From the NCDR LAAO Registry.
Impact of Preprocedure Imaging for Left Atrial Appendage Occlusion: Insights From the NCDR LAAO Registry.
复制标题
术前影像对左心耳闭塞的影响：NCDR LAAO 登记处的见解。
DOI：
10.1016/j.jcin.2023.05.008
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Friedman,DanielJ
中科院分区：
文献类型：
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作者：
Clarke,John-RossD;Higgins,AngelaY;Wang,Yongfei;Faridi,KamilF;Curtis,JepthaA;Freeman,JamesV;Friedman,DanielJ
背景术前影像学检查对左心耳封堵术（LAAO）安全性和有效性的影响尚不清楚。目的本研究旨在确定术前计算机断层扫描（CT）/心脏磁共振（CMR）的使用率方法国家心血管数据登记处LAAO登记处用于评估尝试LAAO的患者，2016年1月1日至2021年6月30日期间的WATCHMAN和WATCHMAN FLX设备。通过使用与不使用术前CT/CMR比较LAAO手术的安全性和有效性。关注的结局包括植入成功（器械展开和释放）、器械成功（器械释放，器械周围泄漏<5 mm）和手术成功（器械释放，器械周围泄漏<5 mm，无院内主要不良事件[MAE]）。使用多变量逻辑回归来评估术前成像与结果之间的关系。结果本研究中114，384例手术中，18.2%（n = 20，851）使用了术前CT/CMR。CT/CMR的使用在政府和大学医院以及中西部和南部的医院中更为常见;在未控制的高血压、肾功能异常和既往无血栓栓塞的患者中不太常见。植入成功率、器械成功率和手术成功率分别为93.4%、91.2%和89.4%。术前CT/CMR与植入成功（OR：1.08; 95% CI：1.00-1.17）、器械成功（OR：1.10; 95% CI：1.04-1.16）和手术成功（OR：1.07; 95% CI：1.02-1.13）的可能性增加独立相关。MAE不常见（2.3%），与术前CT/CMR的使用无关（OR：1.02; 95%CI：0.92-1.12）。结论术前CT/CMR与成功LAAO植入的可能性增加有关;然而，受益程度似乎很小，与MAE无关。
BackgroundThe impact of preprocedure imaging on the safety and effectiveness of left atrial appendage occlusion (LAAO) remains unclear.ObjectivesThis study sought to determine the rates of use of preprocedure computed tomography (CT)/cardiac magnetic resonance (CMR) and its association with safety and effectiveness of LAAO procedures.MethodsThe National Cardiovascular Data Registry LAAO Registry was used to evaluate patients who underwent attempted LAAO with the WATCHMAN and WATCHMAN FLX devices between January 1, 2016, and June 30, 2021. Safety and effectiveness of LAAO procedures was compared by use vs nonuse of preprocedural CT/CMR. Outcomes of interest included implantation success (deployment and release of device), device success (device released with peridevice leak <5 mm), and procedure success (device released with peridevice leak <5 mm and no in-hospital major adverse events [MAE]). Multivariable logistic regression was used to assess the relationship between preprocedure imaging and outcomes.ResultsPreprocedure CT/CMR was used for 18.2% (n = 20,851) of the 114,384 procedures in this study. CT/CMR use was more common among government and university hospitals and hospitals in the Midwest and South; it was less common among patients with uncontrolled hypertension, with abnormal renal function, and without prior thromboembolism. Overall rates of implantation success, device success, and procedure success were 93.4%, 91.2%, and 89.4%, respectively. Preprocedure CT/CMR was independently associated with an increased likelihood of implantation success (OR: 1.08; 95% CI: 1.00-1.17), device success (OR: 1.10; 95% CI: 1.04-1.16), and procedural success (OR: 1.07; 95% CI: 1.02-1.13). MAE were uncommon (2.3%) and not associated with use of preprocedure CT/CMR (OR: 1.02; 95% CI: 0.92-1.12).ConclusionsPreprocedure CT/CMR was associated with an increased likelihood of successful LAAO implantation; however, the magnitude of benefit appears small and it was not associated with MAE.