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Simard, Trevor; Jung, Richard G; Lehenbauer, Kyle; Piayda, Kerstin; Pracoń, Radoslaw; Jackson, Gregory G; Flores-Umanzor, Eduardo; Faroux, Laurent; Korsholm, Kasper; Chun, Julian K R; Chen, Shaojie; Maarse, Moniek; Montrella, Kristi; Chaker, Zakeih; Spoon, Jocelyn N; Pastormerlo, Luigi E; Meincke, Felix; Sawant, Abhishek C; Moldovan, Carmen M; Qintar, Mohammed; Aktas, Mehmet K; Branca, Luca; Radinovic, Andrea; Ram, Pradhum; El-Zein, Rayan S; Flautt, Thomas; Ding, Wern Yew; Sayegh, Bassel; Benito-González, Tomás; Lee, Oh-Hyun; Badejoko, Solomon O; Paitazoglou, Christina; Karim, Nabeela; Zaghloul, Ahmed M; Agrawal, Himanshu; Kaplan, Rachel M; Alli, Oluseun; Ahmed, Aamir; Suradi, Hussam S; Knight, Bradley P; Alla, Venkata M; Panaich, Sidakpal S; Wong, Tom; Bergmann, Martin W; Chothia, Rashaad; Kim, Jung-Sun; Pérez de Prado, Armando; Bazaz, Raveen; Gupta, Dhiraj; Valderrabano, Miguel; Sanchez, Carlos E; El Chami, Mikhael F; Mazzone, Patrizio; Adamo, Marianna; Ling, Fred; Wang, Dee Dee; O'Neill, William; Wojakowski, Wojtek; Pershad, Ashish; Berti, Sergio; Spoon, Daniel; Kawsara, Akram; Jabbour, George; Boersma, Lucas V A; Schmidt, Boris; Nielsen-Kudsk, Jens Erik; Rodés-Cabau, Josep; Freixa, Xavier; Ellis, Christopher R; Fauchier, Laurent; Demkow, Marcin; Sievert, Horst; Main, Michael L; Hibbert, Benjamin; Holmes, Jr, David R; Alkhouli, Mohamad
Journal of the American College of Cardiology, 07/2021, Volume: 78, Issue: 4Journal Article
Device-related thrombus (DRT) has been considered an Achilles' heel of left atrial appendage occlusion (LAAO). However, data on DRT prediction remain limited. This study constructed a DRT registry via a multicenter collaboration aimed to assess outcomes and predictors of DRT. Thirty-seven international centers contributed LAAO cases with and without DRT (device-matched and temporally related to the DRT cases). This study described the management patterns and mid-term outcomes of DRT and assessed patient and procedural predictors of DRT. A total of 711 patients (237 with and 474 without DRT) were included. Follow-up duration was similar in the DRT and no-DRT groups, median 1.8 years (interquartile range: 0.9-3.0 years) versus 1.6 years (interquartile range: 1.0-2.9 years), respectively (P = 0.76). DRTs were detected between days 0 to 45, 45 to 180, 180 to 365, and >365 in 24.9%, 38.8%, 16.0%, and 20.3% of patients. DRT presence was associated with a higher risk of the composite endpoint of death, ischemic stroke, or systemic embolization (HR: 2.37; 95% CI, 1.58-3.56; P < 0.001) driven by ischemic stroke (HR: 3.49; 95% CI: 1.35-9.00; P = 0.01). At last known follow-up, 25.3% of patients had DRT. Discharge medications after LAAO did not have an impact on DRT. Multivariable analysis identified 5 DRT risk factors: hypercoagulability disorder (odds ratio OR: 17.50; 95% CI: 3.39-90.45), pericardial effusion (OR: 13.45; 95% CI: 1.46-123.52), renal insufficiency (OR: 4.02; 95% CI: 1.22-13.25), implantation depth >10 mm from the pulmonary vein limbus (OR: 2.41; 95% CI: 1.57-3.69), and non-paroxysmal atrial fibrillation (OR: 1.90; 95% CI: 1.22-2.97). Following conversion to risk factor points, patients with ≥2 risk points for DRT had a 2.1-fold increased risk of DRT compared with those without any risk factors. DRT after LAAO is associated with ischemic events. Patient- and procedure-specific factors are associated with the risk of DRT and may aid in risk stratification of patients referred for LAAO.
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