Korean Circ J.  2021 Jul;51(7):626-638. 10.4070/kcj.2020.0527.

Percutaneous Left Atrial Appendage Occlusion Yields Favorable Neurological Outcomes in Patients with Non-Valvular Atrial Fibrillation

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Korea
  • 2Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
  • 3Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 4Data Science Team (Biostatistician), Center for Digital Health, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
  • 5Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
  • 6Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
  • 7Division of Cardiology, Gachon University Gil Medical Center, Incheon, Korea
  • 8Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
  • 9Department of Neurology, Changwon Fatima Hospital, Changwon, Korea
  • 10Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
  • 11Department of Neurology, Gangnam Severance Hospital, Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea
  • 12Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
  • 13Department of Neurology, Pusan National University Hospital, Pusan National University College of Medicine and Biomedical Research Institute, Busan, Korea
  • 14Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, China
  • 15Department of Cardiology, Hospital Clinic of Barcelona, University of Barcelona, Catalonia, Spain
  • 16Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
  • 17Department of Cardiology, Charite University Hospital Campus Benjamin Franklin, Berlin, Germany

Abstract

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.

Keyword

Stroke; Atrial fibrillation; Atrial appendage; Factor Xa inhibitors
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