1
|
Myrda K, Streb W, Wojakowski W, Piegza J, Mitręga K, Smolka G, Nowak J, Podolecki T, Gasiewska-Żurek E, Nowowiejska-Wiewióra A, Smolarek-Nicpoń M, Skrzypek M, Gąsior M, Kalarus Z. Long-term outcomes in patients after left atrial appendage occlusion: The results from the LAAO SILESIA registry. Kardiol Pol 2022; 80:332-338. [PMID: 35167113 DOI: 10.33963/kp.a2022.0047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The benefits of oral anticoagulation (OAC) therapy are undeniable. However, such treatment is contraindicated in 2%-10% of patients. According to the latest guidelines, percutaneous left atrial appendage occlusion (LAAO) may be considered in stroke prevention. AIMS We analyzed the data of patients from the Polish population, who had undergone LAAO procedures in the Silesian Province based on limited reports. METHODS The data from the SILCARD database of all patients who underwent LAAO between 2006 and 2019, and the data from the databases of the centers performing the procedures in the Silesian Province were included in the LAAO SILESIA registry. We analyzed the efficacy and safety of the procedure and its relationship with the occurrence of stroke and bleeding in the post-hospital follow-up. RESULTS We analyzed 649 patients with the mean values of CHA2DS2-VASc and HAS-BLED scores of 4.1 and 3.2, respectively. The predominant indication for LAAO was a history of bleeding during OAC. The most frequent in-hospital major adverse cardiac events were anemia, which required blood transfusion (5.5%), and pericardial effusion, which was treated either conservatively (0.9%) or interventionally (1.2%). During hospitalization, stroke was detected in 4 patients and three patients died of any cause. LAAO reduced the annual risk of stroke by 84% and the annual risk of bleeding by 27%. CONCLUSIONS Based on a "real-life" cohort of patients from the Silesian Province, we concluded that LAAO is related to low in-hospital major cardiovascular adverse events. In the long-term follow-up, LAAO reduced the rates of stroke and bleeding.
Collapse
Affiliation(s)
- Krzysztof Myrda
- 3rd Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland.
| | - Witold Streb
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Division of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, 3rd Division of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Jacek Piegza
- 3rd Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Katarzyna Mitręga
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Division of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Grzegorz Smolka
- Department of Cardiology and Structural Heart Diseases, 3rd Division of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Jolanta Nowak
- 3rd Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland.,3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Tomasz Podolecki
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Division of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Ewa Gasiewska-Żurek
- Department of Cardiology and Structural Heart Diseases, 3rd Division of Cardiology, Medical University of Silesia, Katowice, Poland
| | | | - Malwina Smolarek-Nicpoń
- Department of Cardiology and Structural Heart Diseases, 3rd Division of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Michał Skrzypek
- Department of Biostatistics, School of Health Sciences in Bytom, Medical University of Silesia, Katowice, Poland
| | - Mariusz Gąsior
- 3rd Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland.,3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Zbigniew Kalarus
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Division of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
| |
Collapse
|
2
|
Wańha W, Januszek R, Kołodziejczak M, Kuźma Ł, Tajstra M, Figatowski T, Smolarek-Nicpoń M, Gruz-Kwapisz M, Tomasiewicz B, Bartuś J, Łoś A, Jagielak D, Roleder T, Włodarczak A, Kulczycki J, Kowalewski M, Hudziak D, Stachowiak P, Gorący J, Sierakowska K, Reczuch K, Jaguszewski M, Dobrzycki S, Smolka G, Bartuś S, Ochała A, Gąsior M, Wojakowski W. Procedural and 1-year outcomes following large vessel coronary artery perforation treated by covered stents implantation: Multicentre CRACK registry. PLoS One 2021; 16:e0249698. [PMID: 33979357 PMCID: PMC8115813 DOI: 10.1371/journal.pone.0249698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background Data regarding the clinical outcomes of covered stents (CSs) used to seal coronary artery perforations (CAPs) in the all-comer population are scarce. The aim of the CRACK Registry was to evaluate the procedural, 30-days and 1-year outcomes after CAP treated by CS implantation. Methods This multicenter all-comer registry included data of consecutive patients with CAP treated by CS implantation. The primary endpoint was the composite of major adverse cardiac events (MACEs), defined as cardiac death, target lesion revascularization (TLR), and myocardial infarction (MI). Results The registry included 119 patients (mean age: 68.9 ± 9.7 years, 55.5% men). Acute coronary syndrome, including: unstable angina 21 (17.6%), NSTEMI 26 (21.8%), and STEMI 26 (21.8%), was the presenting diagnosis in 61.3%, and chronic coronary syndromes in 38.7% of patients. The most common lesion type, according to ACC/AHA classification, was type C lesion in 47 (39.5%) of cases. A total of 52 patients (43.7%) had type 3 Ellis classification, 28 patients (23.5%) had type 2 followed by 39 patients (32.8%) with type 1 perforation. Complex PCI was performed in 73 (61.3%) of patients. Periprocedural death occurred in eight patients (6.7%), of which two patients had emergency cardiac surgery. Those patients were excluded from the one-year analysis. Successful sealing of the perforation was achieved in 99 (83.2%) patients. During the follow-up, 26 (26.2%) patients experienced MACE [7 (7.1%) cardiac deaths, 13 (13.1%) TLR, 11 (11.0%) MIs]. Stent thrombosis (ST) occurred in 6 (6.1%) patients [4(4.0%) acute ST, 1(1.0%) subacute ST and 1(1.0%) late ST]. Conclusions The use of covered stents is an effective treatment of CAP. The procedural and 1-year outcomes of CAP treated by CS implantation showed that such patients should remain under follow-up due to relatively high risk of MACE.
Collapse
Affiliation(s)
- Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
- * E-mail:
| | - Rafał Januszek
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Michalina Kołodziejczak
- Department of Anaesthesiology and Intensive Care, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Mateusz Tajstra
- Third Department of Cardiology, Medical University of Silesia, Zabrze, Poland
| | - Tomasz Figatowski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Malwina Smolarek-Nicpoń
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Monika Gruz-Kwapisz
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Jerzy Bartuś
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Łoś
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Dariusz Jagielak
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Tomasz Roleder
- Regional Specialist Hospital, Research and Development Center, Wroclaw, Poland
| | | | - Jan Kulczycki
- Department of Cardiology, Miedziowe Centrum Zdrowia, Lubin, Poland
| | - Mariusz Kowalewski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
| | - Damian Hudziak
- Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland
| | - Paweł Stachowiak
- Regional Specialist Hospital, Research and Development Center, Wroclaw, Poland
- Department of Cardiology, Pomeranian Medical University, Szczecin, Poland
| | - Jarosław Gorący
- Department of Cardiology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Sierakowska
- Department of Anaesthesiology and Intensive Care, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | | | - Miłosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Grzegorz Smolka
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Stanisław Bartuś
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Ochała
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Mariusz Gąsior
- Third Department of Cardiology, Medical University of Silesia, Zabrze, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| |
Collapse
|