経皮的左心耳閉鎖術は経口抗凝固療法にもかかわらず心原性脳卒中を発症した患者において、多施設共同コホート研究

Left atrial appendage closure (LAAC) may be used in atrial fibrillation (AF) patients with previous cardioembolic stroke (CS) despite adequate oral anticoagulation (OAC). The aim of this study is to evaluate the safety and efficacy of the hybrid strategy LAAC and OAC in patients with OAC failure.

In this multicenter study, patients with an ascertained CS while on adequate OAC were divided according to the treatment strategy after the index event (LAAC vs. medical therapy [MT] group). Other potential embolic sources were excluded and all patients continued OAC after the index event. The primary endpoint was a composite of all cause death, CS, and major bleeding.

Among the 109 patients included in the study, 44 (40%) formed the LAAC group and 65 (60%) the MT group. At the median follow-up of 48 (IQR 14) months, the LAAC group reported lower rate of primary endpoint (HR 0.398, 95%CI 0.201 - 0.781, p=0.008) and CS recurrence (HR 0.273, 95%CI 0.060 - 0.852, p = 0.041). CHA₂DS₂VA, NIHSS and acute reperfusion therapy predicted the primary endpoint while CHA₂DS₂VA and NIHSS predicted CS recurrence. Results were confirmed in a propensity-score matching analysis. The calculated annualized rate of CS was 2.0 per 100 patients-years in the LAAC group and 7.8 per 100 patients-years in the MT group.

In patients with CS due to OAC failure, the hybrid strategy LAAC and OAC was associated with better long-term outcome compared to OAC alone.