Related Experiment Video
Updated: Dec 30, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Risk stratification in patients undergoing interventional left atrial appendage occlusion-Prognostic impact of
Michael Gotzmann1, Dinah S Choudhury2, Maximilian Hogeweg1
1Cardiovascular Center, St. Josef Hospital Bochum, Ruhr-University, Bochum, Germany.
Insights
Interventional left atrial appendage (LAA) closure is an option for stroke prevention. Logistic EuroSCORE II greater than 2% independently predicts mortality in these patients, aiding risk stratification.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Interventional left atrial appendage (LAA) closure offers an alternative to oral anticoagulation for stroke prophylaxis, especially in patients with high bleeding risk due to comorbidities.
- The clinical benefit of LAA occlusion in multimorbid patients with reduced prognosis remains a concern.
Purpose of the Study:
- To identify independent preprocedural risk factors for improved risk stratification in patients undergoing interventional LAA occlusion.
- To evaluate the prognostic value of logistic EuroSCORE II and the impact of end-stage renal disease on outcomes.
Main Methods:
- A consecutive series of 128 patients undergoing interventional LAA occlusion with the Amplatzer device were studied.
- Preprocedural risk assessment utilized the logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) II.
- Primary endpoint was all-cause mortality; secondary endpoints included thromboembolic events and severe bleeding.
Main Results:
- During a mean follow-up of 781 days, 27% of patients died.
- Logistic EuroSCORE II > 2% was the sole independent predictor of mid-term mortality (HR 4.55, P=.005).
- End-stage renal disease (26% of patients) did not significantly impact mortality, thromboembolic events, or bleeding.
Conclusions:
- Preprocedural logistic EuroSCORE II assessment provides independent prognostic information in patients undergoing interventional LAA occlusion.
- Logistic EuroSCORE II can enhance risk stratification for these highly selected patients.
- End-stage renal failure was not associated with significantly worse outcomes in this cohort.
Background:
Interventional closure of the left atrial appendage (LAA) is an alternative option to stroke prophylaxis, particularly in multimorbid patients with a high risk of bleeding under oral anticoagulation. Due to the multiple comorbidities, the prognosis of patients is reduced, and the clinical benefit of the procedure is therefore questionable in the individual patient.
Hypothesis:
The present study aims to identify independent preprocedural risk factors to improve risk stratification in these highly selected patients.
Methods:
This study consecutively included 128 patients who received an interventional LAA occlusion with Amplatzer device (St Jude Medical, St Paul, Minnesota). The preinterventional risk assessment was performed with the logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) II. The primary endpoint was all-cause mortality. Secondary endpoints were thromboembolic events and severe bleeding.
Results:
During a follow-up of 781 ± 498 days the primary endpoint (all-cause mortality) was reached in 35 patients (27%). The only independent predictor of mid-term mortality was a logistic EuroSCORE II > 2% (Hazard risk [HR] 4.55, confidence interval [CI] 1.599-12.966, P = .005). In our study, 33 patients (26%) suffered from end-stage renal disease which was not associated with increased mortality (P = .371), increased thromboembolic events (P = .475), or severe bleeding (P = .613).
Conclusions:
In patients undergoing interventional LAA occlusion, preprocedural assessment of logistic EuroSCORE II provide independent prognostic information. This parameter might help to improve risk stratification in these highly selected patients. In contrast, terminal renal failure was not associated with a significantly worse outcome.
More Related Videos
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests