Percutaneous left atrial appendage occlusion yields favorable neurological outcomes in patients with non-valvular atrial fibrillation

Oh Hyun Lee, Young Dae Kim, Jung Sun Kim, Nak Hoon Son, Hui Nam Pak, Boyoung Joung, Cheol Woong Yu, Hyun Jong Lee, Woong Chol Kang, Eun Seok Shin, Rak Kyeong Choi, Do Sun Lim, Yo Han Jung, Hye Yeon Choi, Kyung Yul Lee, Bang Hoon Cho, Sang Won Han, Joong Hyun Park, Han Jin Cho, Hyung Jong ParkHyo Suk Nam, Ji Hoe Heo, Chak Yu So, Gary Shing Him Cheung, Yat Yin Lam, Xavier Freixa, Apostolos Tzikas, Yangsoo Jang, Jai Wun Park

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Background and Objectives: Prior studies have shown that stroke patients treated with percutaneous left atrial appendage occlusion (LAAO) for non-valvular atrial fibrillation (NVAF) experience better outcomes than similar patients treated with warfarin. We investigated the impact of percutaneous left atrial appendage closure on post-stroke neurological outcomes in NVAF patients, compared with non-vitamin K antagonist oral anticoagulant (NOAC) therapy. Methods: Medical records for 1,427 patients in multiple registries and for 1,792 consecutive patients at 6 Korean hospitals were reviewed with respect to LAAO or NOAC treatment. Stroke severity in patients who experienced ischemic stroke or transient ischemic attack after either treatment was assessed with modified Rankin Scale (mRS) scoring at hospital discharge and at 3 and 12 months post-stroke. Results: mRS scores were significantly lower in LAAO patients at 3 (p<0.01) and 12 months (p<0.01) post-stroke, despite no significant differences in scores before the ischemic cerebrovascular event (p=0.22). The occurrences of disabling ischemic stroke in the LAAO and NOAC groups were 36.7% and 44.2% at discharge (p=0.47), 23.3% and 44.2% at 3 months post-stroke (p=0.04), and 13.3% and 43.0% at 12 months post-stroke (p=0.01), respectively. Recovery rates for disabling ischemic stroke at discharge to 12 months post-stroke were significantly higher for LAAO patients (50.0%) than for NOAC patients (5.6%) (p<0.01). Conclusions: Percutaneous LAAO was associated with more favorable neurological outcomes after ischemic cerebrovascular event than NOAC treatment.

Original languageEnglish
Article numbere74
JournalKorean Circulation Journal
Volume51
DOIs
Publication statusPublished - 2021 May
Externally publishedYes

Keywords

  • Atrial appendage
  • Atrial fibrillation
  • Factor Xa inhibitors
  • Stroke

ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

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