Left atrial appendage occlusion study III-Kidney substudy

Optimal anticoagulation in patients with chronic kidney disease and atrial fibrillation is unclear. Effect of left atrial appendage occlusion may differ in these patients. We conducted a secondary analysis of the Left Atrial Appendage Occlusion Study (LAAOS III) to investigate METHODS: LAAOS III randomized 4,811 participants with atrial fibrillation undergoing cardiac surgery. Baseline serum creatinine measurement was available for 4,768 participants (99.9%). We estimated the Glomerular Filtration Rate (eGFR) using the 2021 Chronic Kidney Disease -Epidemiology Collaboration equation. We investigated the effect of left atrial appendage occlusion using Cox-proportional hazards model with baseline kidney function as continuous and categorical variables.

Among 4,768 participants, 67.5% were men and the median age was 71.2 years. Occluding the left atrial appendage demonstrated similar effects after adjusting for eGFR; occlusion was associated with significant reduced risk of stroke compared to no occlusion (HR0.67, 95% CI 0.53-0.85, P = .001). There was no difference in all-cause mortality (HR0.99, 95% CI 0.88-1.12, P = .88), cardiovascular deaths (HR0.93, 95% CI 0.80-1.09, P = .36), hospitalizations for heart failure (HR1.13, 95% CI 0.91-1.39, P = 0.27), major bleeding (HR0.92, 95% CI 0.78-1.10, P = .37), and myocardial infarction (HR0.86, 95% CI 0.59-1.27, P = .45). The P-value for interaction for eGFR was not significant for any outcome.

The effects of surgical left atrial appendage occlusion in participants with impaired kidney function was consistent with findings from LAAOS III. Left atrial appendage occlusion was associated with reduced stroke without increased risk of serious adverse events.

LAAOS III ClinicalTrials.gov number: NCT01516151. https://clinicaltrials.gov/study/NCT01561651.