Risk Stratification in Patients Who Underwent Percutaneous Left Atrial Appendage Occlusion

Left atrial appendage occlusion (LAAO) is effective in preventing thromboembolism. Risk stratification tools could help identify patients at risk for early mortality after LAAO. In this study, we validated and recalibrated a clinical risk score (CRS) to predict risk of all-cause mortality after LAAO...

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Published in:The American journal of cardiology 2023-08, Vol.200, p.50-56
Main Authors: Segar, Matthew W., Zhang, Allan, Paisley, Robert D., Badjatiya, Anish, Lambeth, Kaleb D., Mullins, Karen, Razavi, Mehdi, Molina-Razavi, Joanna E., Rasekh, Abdi, Saeed, Mohammad
Format: Article
Language:English
Subjects:
Atrial Appendage - surgery
Atrial Fibrillation - complications
Atrial Fibrillation - surgery
Body mass
Body mass index
Body size
Cardiac arrhythmia
Child, Preschool
Congestive heart failure
Diabetes
Diabetes mellitus
Fibrillation
Gender
Glomerular filtration rate
Health hazards
Heart Failure
Hemoglobin
Hospitalization
Humans
Hypertension
Infant
Intervention
Medicaid
Medicare
Mortality
Observational studies
Occlusion
Patients
Risk Assessment
Risk Factors
Statistical models
Stroke
Stroke - epidemiology
Stroke - etiology
Stroke - prevention & control
Surveillance
Thromboembolism
Treatment Outcome
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cited_by cdi_FETCH-LOGICAL-c393t-cc8a824ef097d9ccc7d813d6003e7587104f7c55296901fdfadc13dc09ad50813
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container_title The American journal of cardiology
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creator Segar, Matthew W.
Zhang, Allan
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Razavi, Mehdi
Molina-Razavi, Joanna E.
Rasekh, Abdi
Saeed, Mohammad
description Left atrial appendage occlusion (LAAO) is effective in preventing thromboembolism. Risk stratification tools could help identify patients at risk for early mortality after LAAO. In this study, we validated and recalibrated a clinical risk score (CRS) to predict risk of all-cause mortality after LAAO. This study used data from patients who underwent LAAO in a single-center, tertiary hospital. A previously developed CRS using 5 variables (age, body mass index [BMI], diabetes, heart failure, and estimated glomerular filtration rate) was applied to each patient to assess risk of all-cause mortality at 1 and 2 years. The CRS was recalibrated to the present study cohort and compared with established atrial fibrillation-specific (CHA2DS2-VASc and HAS-BLED) and generalized (Walter index) risk scores. Cox proportional hazard models were used to assess the risk of mortality and discrimination was assessed by Harrel C-index. Among 223 patients, the 1- and 2-year mortality rates were 6.7% and 11.2%, respectively. With the original CRS, only low BMI (
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Risk stratification tools could help identify patients at risk for early mortality after LAAO. In this study, we validated and recalibrated a clinical risk score (CRS) to predict risk of all-cause mortality after LAAO. This study used data from patients who underwent LAAO in a single-center, tertiary hospital. A previously developed CRS using 5 variables (age, body mass index [BMI], diabetes, heart failure, and estimated glomerular filtration rate) was applied to each patient to assess risk of all-cause mortality at 1 and 2 years. The CRS was recalibrated to the present study cohort and compared with established atrial fibrillation-specific (CHA2DS2-VASc and HAS-BLED) and generalized (Walter index) risk scores. Cox proportional hazard models were used to assess the risk of mortality and discrimination was assessed by Harrel C-index. Among 223 patients, the 1- and 2-year mortality rates were 6.7% and 11.2%, respectively. With the original CRS, only low BMI (&lt;23 kg/m2) was a significant predictor of all-cause mortality (hazard ratio [HR] [95% CI] 2.76 [1.03 to 7.35]; p = 0.04). With recalibration, BMI &lt;29 kg/m2 and estimated glomerular filtration rate &lt;60 ml/min/1.73 m2 were significantly associated with an increased risk of death (HR [95% CI] 3.24 [1.29 to 8.13] and 2.48 [1.07 to 5.74], respectively), with a trend toward significance noted for history of heart failure (HR [95% CI] 2.13 [0.97 to 4.67], p = 0.06). Recalibration improved the discriminative ability of the CRS from 0.65 to 0.70 and significantly outperformed established risk scores (CHA2DS2-VASc = 0.58, HAS-BLED = 0.55, Walter index = 0.62). In this single-center, observational study, the recalibrated CRS accurately risk stratified patients who underwent LAAO and significantly outperformed established atrial fibrillation-specific and generalized risk scores. In conclusion, clinical risk scores should be considered as an adjunct to standard of care when evaluating a patient's candidacy for LAAO.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2023.05.019</identifier><identifier>PMID: 37295180</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Atrial Appendage - surgery ; Atrial Fibrillation - complications ; Atrial Fibrillation - surgery ; Body mass ; Body mass index ; Body size ; Cardiac arrhythmia ; Child, Preschool ; Congestive heart failure ; Diabetes ; Diabetes mellitus ; Fibrillation ; Gender ; Glomerular filtration rate ; Health hazards ; Heart Failure ; Hemoglobin ; Hospitalization ; Humans ; Hypertension ; Infant ; Intervention ; Medicaid ; Medicare ; Mortality ; Observational studies ; Occlusion ; Patients ; Risk Assessment ; Risk Factors ; Statistical models ; Stroke ; Stroke - epidemiology ; Stroke - etiology ; Stroke - prevention &amp; control ; Surveillance ; Thromboembolism ; Treatment Outcome</subject><ispartof>The American journal of cardiology, 2023-08, Vol.200, p.50-56</ispartof><rights>2023 Elsevier Inc.</rights><rights>Copyright © 2023 Elsevier Inc. All rights reserved.</rights><rights>2023. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c393t-cc8a824ef097d9ccc7d813d6003e7587104f7c55296901fdfadc13dc09ad50813</citedby><cites>FETCH-LOGICAL-c393t-cc8a824ef097d9ccc7d813d6003e7587104f7c55296901fdfadc13dc09ad50813</cites><orcidid>0000-0001-6100-0897</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37295180$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Segar, Matthew W.</creatorcontrib><creatorcontrib>Zhang, Allan</creatorcontrib><creatorcontrib>Paisley, Robert D.</creatorcontrib><creatorcontrib>Badjatiya, Anish</creatorcontrib><creatorcontrib>Lambeth, Kaleb D.</creatorcontrib><creatorcontrib>Mullins, Karen</creatorcontrib><creatorcontrib>Razavi, Mehdi</creatorcontrib><creatorcontrib>Molina-Razavi, Joanna E.</creatorcontrib><creatorcontrib>Rasekh, Abdi</creatorcontrib><creatorcontrib>Saeed, Mohammad</creatorcontrib><title>Risk Stratification in Patients Who Underwent Percutaneous Left Atrial Appendage Occlusion</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Left atrial appendage occlusion (LAAO) is effective in preventing thromboembolism. Risk stratification tools could help identify patients at risk for early mortality after LAAO. In this study, we validated and recalibrated a clinical risk score (CRS) to predict risk of all-cause mortality after LAAO. This study used data from patients who underwent LAAO in a single-center, tertiary hospital. A previously developed CRS using 5 variables (age, body mass index [BMI], diabetes, heart failure, and estimated glomerular filtration rate) was applied to each patient to assess risk of all-cause mortality at 1 and 2 years. The CRS was recalibrated to the present study cohort and compared with established atrial fibrillation-specific (CHA2DS2-VASc and HAS-BLED) and generalized (Walter index) risk scores. Cox proportional hazard models were used to assess the risk of mortality and discrimination was assessed by Harrel C-index. Among 223 patients, the 1- and 2-year mortality rates were 6.7% and 11.2%, respectively. 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Risk stratification tools could help identify patients at risk for early mortality after LAAO. In this study, we validated and recalibrated a clinical risk score (CRS) to predict risk of all-cause mortality after LAAO. This study used data from patients who underwent LAAO in a single-center, tertiary hospital. A previously developed CRS using 5 variables (age, body mass index [BMI], diabetes, heart failure, and estimated glomerular filtration rate) was applied to each patient to assess risk of all-cause mortality at 1 and 2 years. The CRS was recalibrated to the present study cohort and compared with established atrial fibrillation-specific (CHA2DS2-VASc and HAS-BLED) and generalized (Walter index) risk scores. Cox proportional hazard models were used to assess the risk of mortality and discrimination was assessed by Harrel C-index. Among 223 patients, the 1- and 2-year mortality rates were 6.7% and 11.2%, respectively. With the original CRS, only low BMI (&lt;23 kg/m2) was a significant predictor of all-cause mortality (hazard ratio [HR] [95% CI] 2.76 [1.03 to 7.35]; p = 0.04). With recalibration, BMI &lt;29 kg/m2 and estimated glomerular filtration rate &lt;60 ml/min/1.73 m2 were significantly associated with an increased risk of death (HR [95% CI] 3.24 [1.29 to 8.13] and 2.48 [1.07 to 5.74], respectively), with a trend toward significance noted for history of heart failure (HR [95% CI] 2.13 [0.97 to 4.67], p = 0.06). Recalibration improved the discriminative ability of the CRS from 0.65 to 0.70 and significantly outperformed established risk scores (CHA2DS2-VASc = 0.58, HAS-BLED = 0.55, Walter index = 0.62). In this single-center, observational study, the recalibrated CRS accurately risk stratified patients who underwent LAAO and significantly outperformed established atrial fibrillation-specific and generalized risk scores. 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subjects Atrial Appendage - surgery
Atrial Fibrillation - complications
Atrial Fibrillation - surgery
Body mass
Body mass index
Body size
Cardiac arrhythmia
Child, Preschool
Congestive heart failure
Diabetes
Diabetes mellitus
Fibrillation
Gender
Glomerular filtration rate
Health hazards
Heart Failure
Hemoglobin
Hospitalization
Humans
Hypertension
Infant
Intervention
Medicaid
Medicare
Mortality
Observational studies
Occlusion
Patients
Risk Assessment
Risk Factors
Statistical models
Stroke
Stroke - epidemiology
Stroke - etiology
Stroke - prevention & control
Surveillance
Thromboembolism
Treatment Outcome
title Risk Stratification in Patients Who Underwent Percutaneous Left Atrial Appendage Occlusion
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