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Published on: February 26, 2013
Percutaneous Left Atrial Appendage Occlusion Yields Favorable Neurological Outcomes in Patients with Non-Valvular
Oh Hyun Lee1, Young Dae Kim2, Jung Sun Kim3
1Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Korea.
Insights
Percutaneous left atrial appendage occlusion (LAAO) showed better neurological outcomes post-stroke compared to non-vitamin K antagonist oral anticoagulants (NOACs). LAAO patients had significantly lower stroke severity scores and higher recovery rates.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Prior studies suggest percutaneous left atrial appendage occlusion (LAAO) offers better outcomes than warfarin for non-valvular atrial fibrillation (NVAF) patients.
- Non-vitamin K antagonist oral anticoagulants (NOACs) are also used for stroke prevention in NVAF.
Purpose of the Study:
- To compare the neurological outcomes of percutaneous left atrial appendage closure (LAAC) versus NOAC therapy in NVAF patients post-stroke.
- To assess stroke severity and recovery rates using modified Rankin Scale (mRS) scores.
Main Methods:
- Retrospective review of medical records from multiple registries and 6 Korean hospitals.
- Inclusion of 1,427 patients treated with LAAO and 1,792 patients treated with NOACs.
- Assessment of stroke severity (mRS) at discharge, 3 months, and 12 months post-event.
Main Results:
- LAAO patients demonstrated significantly lower mRS scores at 3 and 12 months post-stroke compared to NOAC patients.
- The incidence of disabling ischemic stroke was lower in the LAAO group at 3 and 12 months.
- Recovery rates for disabling ischemic stroke were substantially higher for LAAO patients (50.0%) versus NOAC patients (5.6%) by 12 months.
Conclusions:
- Percutaneous LAAO is associated with more favorable neurological outcomes following an ischemic cerebrovascular event compared to NOAC treatment.
- LAAC may represent a superior treatment strategy for stroke prevention in select NVAF patients.
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.
