Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion

Trevor Simard; Richard G. Jung; Kyle Lehenbauer; Kerstin Piayda; Radoslaw Pracoń; Gregory G. Jackson; Eduardo Flores-Umanzor; Laurent Faroux; Kasper Korsholm; Julian K.R. Chun; Shaojie Chen; Moniek Maarse; Kristi Montrella; Zakeih Chaker; Jocelyn N. Spoon; Luigi E. Pastormerlo; Felix Meincke; Abhishek C. Sawant; Carmen M. Moldovan; Mohammed Qintar; Mehmet K. Aktas; Luca Branca; Andrea Radinovic; Pradhum Ram; Rayan S. El-Zein; Thomas Flautt; Wern Yew Ding; Bassel Sayegh; Tomás Benito-González; Oh Hyun Lee; Solomon O. Badejoko; Christina Paitazoglou; Nabeela Karim; Ahmed M. Zaghloul; Himanshu Agrawal; Rachel M. Kaplan; Oluseun Alli; Aamir Ahmed; Hussam S. Suradi; Bradley P. Knight; Venkata M. Alla; Sidakpal S. Panaich; Tom Wong; Martin W. Bergmann; Rashaad Chothia; Jung Sun Kim; Armando Pérez de Prado; Raveen Bazaz; Dhiraj Gupta; Miguel Valderrabano; Carlos E. Sanchez; Mikhael F. El Chami; Patrizio Mazzone; Marianna Adamo; Fred Ling; Dee Dee Wang; William O'Neill; Wojtek Wojakowski; Ashish Pershad; Sergio Berti; Daniel Spoon; Akram Kawsara; George Jabbour; Lucas V.A. Boersma; Boris Schmidt; Jens Erik Nielsen-Kudsk; Josep Rodés-Cabau; Xavier Freixa; Christopher R. Ellis; Laurent Fauchier; Marcin Demkow; Horst Sievert; Michael L. Main; Benjamin Hibbert; David R. Holmes; Mohamad Alkhouli

doi:10.1016/j.jacc.2021.04.098

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Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion

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Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion

Trevor Simard, Richard G. Jung, Kyle Lehenbauer, Kerstin Piayda, Radoslaw Pracoń, Gregory G. Jackson, Eduardo Flores-Umanzor, Laurent Faroux, Kasper Korsholm, Julian K.R. Chun, …

Journal of the American College of Cardiology, Vol.78(4), pp.297-313

07/27/2021

DOI: https://doi.org/10.1016/j.jacc.2021.04.098

PMID: 34294267

Abstract

Cardiology and Cardiovascular Medicine

Background: Device-related thrombus (DRT) has been considered an Achilles’ heel of left atrial appendage occlusion (LAAO). However, data on DRT prediction remain limited. Objectives: This study constructed a DRT registry via a multicenter collaboration aimed to assess outcomes and predictors of DRT. Methods: Thirty-seven international centers contributed LAAO cases with and without DRT (device-matched and temporally related to the DRT cases). This study described the management patterns and mid-term outcomes of DRT and assessed patient and procedural predictors of DRT. Results: A total of 711 patients (237 with and 474 without DRT) were included. Follow-up duration was similar in the DRT and no-DRT groups, median 1.8 years (interquartile range: 0.9-3.0 years) versus 1.6 years (interquartile range: 1.0-2.9 years), respectively (P = 0.76). DRTs were detected between days 0 to 45, 45 to 180, 180 to 365, and >365 in 24.9%, 38.8%, 16.0%, and 20.3% of patients. DRT presence was associated with a higher risk of the composite endpoint of death, ischemic stroke, or systemic embolization (HR: 2.37; 95% CI, 1.58-3.56; P < 0.001) driven by ischemic stroke (HR: 3.49; 95% CI: 1.35-9.00; P = 0.01). At last known follow-up, 25.3% of patients had DRT. Discharge medications after LAAO did not have an impact on DRT. Multivariable analysis identified 5 DRT risk factors: hypercoagulability disorder (odds ratio [OR]: 17.50; 95% CI: 3.39-90.45), pericardial effusion (OR: 13.45; 95% CI: 1.46-123.52), renal insufficiency (OR: 4.02; 95% CI: 1.22-13.25), implantation depth >10 mm from the pulmonary vein limbus (OR: 2.41; 95% CI: 1.57-3.69), and non-paroxysmal atrial fibrillation (OR: 1.90; 95% CI: 1.22-2.97). Following conversion to risk factor points, patients with ≥2 risk points for DRT had a 2.1-fold increased risk of DRT compared with those without any risk factors. Conclusions: DRT after LAAO is associated with ischemic events. Patient- and procedure-specific factors are associated with the risk of DRT and may aid in risk stratification of patients referred for LAAO.

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Title: Predictors of Device-Related Thrombus Following Percutaneous Left Atrial Appendage Occlusion
Creators: Trevor Simard (Author) - Mayo Clinic College of Medicine and Science
Richard G. Jung (Author) - University of Ottawa
Kyle Lehenbauer (Author) - St Luke Hospital Kansas City
Kerstin Piayda (Author) - CardioVascular Center Frankfurt;Heinrich Heine University Düsseldorf
Radoslaw Pracoń (Author) - Cardinal Stefan Wyszynski Institute of Cardiology
Gregory G. Jackson (Author) - Vanderbilt University
Eduardo Flores-Umanzor (Author) - University of Barcelona
Laurent Faroux (Author) - Université Laval
Kasper Korsholm (Author) - Aarhus University
Julian K.R. Chun (Author) - Markus-Krankenhaus Frankfurt
Shaojie Chen (Author) - Markus-Krankenhaus Frankfurt
Moniek Maarse (Author) - St. Antonius Ziekenhuis;Amsterdam UMC - University of Amsterdam
Kristi Montrella (Author) - University of Pittsburgh
Zakeih Chaker (Author) - West Virginia University
Jocelyn N. Spoon (Author) - International Heart Institute of Montana
Luigi E. Pastormerlo (Author) - Sant'Anna School of Advanced Studies
Felix Meincke (Author) - Asklepios Klinik St. Georg
Abhishek C. Sawant (Author) - Banner University Medical Center
Carmen M. Moldovan (Author) - Medical University of Silesia in Katowice
Mohammed Qintar (Author) - Henry Ford Health System
Mehmet K. Aktas (Author) - University of Rochester
Luca Branca (Author) - Brescia Civil Hospital
Andrea Radinovic (Author) - Vita-Salute San Raffaele University
Pradhum Ram (Author) - Emory University
Rayan S. El-Zein (Author) - Riverside Methodist Hospital
Thomas Flautt (Author) - Houston Methodist Hospital
Wern Yew Ding (Author) - Liverpool Heart and Chest Hospital NHS Foundation Trust
Bassel Sayegh (Author) - University of Pittsburgh;Excela Health Cardiology
Tomás Benito-González (Author) - University Hospital of León
Oh Hyun Lee (Author) - Yonsei University
Solomon O. Badejoko (Author) - St. Joseph Medical Center
Christina Paitazoglou (Author) - Cardiologicum Hamburg
Nabeela Karim (Author) - Royal Brompton and Harefield NHS Foundation Trust
Ahmed M. Zaghloul (Author) - University of Iowa
Himanshu Agrawal (Author) - Department of Medicine
Rachel M. Kaplan (Author) - Northwestern University
Oluseun Alli (Author) - Novant Health Heart and Vascular Institute
Aamir Ahmed (Author) - Rush University
Hussam S. Suradi (Author) - Rush University
Bradley P. Knight (Author) - Northwestern University
Venkata M. Alla (Author) - Department of Medicine
Sidakpal S. Panaich (Author) - University of Iowa
Tom Wong (Author) - Royal Brompton and Harefield NHS Foundation Trust
Martin W. Bergmann (Author) - Cardiologicum Hamburg
Rashaad Chothia (Author) - St. Joseph Medical Center
Jung Sun Kim (Author) - Yonsei University
Armando Pérez de Prado (Author) - University Hospital of León
Raveen Bazaz (Author) - University of Pittsburgh
Dhiraj Gupta (Author) - Liverpool Heart and Chest Hospital NHS Foundation Trust
Miguel Valderrabano (Author) - Houston Methodist Hospital
Carlos E. Sanchez (Author) - Riverside Methodist Hospital
Mikhael F. El Chami (Author) - Emory University
Patrizio Mazzone (Author) - Vita-Salute San Raffaele University
Marianna Adamo (Author) - Brescia Civil Hospital
Fred Ling (Author) - University of Rochester
Dee Dee Wang (Author) - Henry Ford Health System
William O'Neill (Author) - Henry Ford Health System
Wojtek Wojakowski (Author) - Medical University of Silesia in Katowice
Ashish Pershad (Author) - Banner University Medical Center
Sergio Berti (Author) - Sant'Anna School of Advanced Studies
Daniel Spoon (Author) - International Heart Institute of Montana
Akram Kawsara (Author) - West Virginia University
George Jabbour (Author) - University of Pittsburgh
Lucas V.A. Boersma (Author) - St. Antonius Ziekenhuis;Amsterdam UMC - University of Amsterdam
Boris Schmidt (Author) - Markus-Krankenhaus Frankfurt
Jens Erik Nielsen-Kudsk (Author) - Aarhus University
Josep Rodés-Cabau (Author) - Université Laval
Xavier Freixa (Author) - University of Barcelona
Christopher R. Ellis (Author) - Vanderbilt University
Laurent Fauchier (Author) - Hôpital Trousseau, CHU de Tours
Marcin Demkow (Author) - Cardinal Stefan Wyszynski Institute of Cardiology
Horst Sievert (Author) - CardioVascular Center Frankfurt
Michael L. Main (Author) - St Luke Hospital Kansas City
Benjamin Hibbert (Author) - University of Ottawa
David R. Holmes (Author) - Mayo Clinic College of Medicine and Science
Mohamad Alkhouli (Author) - Mayo Clinic College of Medicine and Science
Publication Details: Journal of the American College of Cardiology, Vol.78(4), pp.297-313
Series: 78
Number of pages: 17
Grant note: Dr Maarse has received an unrestricted grant from Boston Scientific. Dr Pérez de Prado has served as a proctor for Boston Scientific. Dr Gupta has served as a proctor for Abbott. Dr Sanchez has served as a speaker and proctor for Boston Scientific. Dr Demkow has served as a proctor for Abbott and Boston Scientific. Dr Alkhouli has served as a consultant for Boston Scientific. Dr Wang has been a consultant for Edwards LifeSciences, Boston Scientific, and Neochord; and has received research grant support from Boston Scientific assigned to employer Henry Ford health system. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Funding Information: The authors acknowledge the contributions of Perry S. Nemecheck, NP (University of Rochester Medical Center) for their dedicated efforts to this work.
Identifiers: 991005930572702656
Academic Unit: General Medicine
Language: English
Resource Type: Journal article