Radoslaw Litwinowicz1, Magdalena Bartus2, Piotr Ceranowicz3, Maciej Brzezinski4, Bogusław Kapelak1, Dhanunjaya Lakkireddy5, Krzysztof Bartus1. 1. Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland. 2. Deopartment of Pharmacology, Jagiellonian University, Krakow, Poland. 3. Department of Physiology, Jagiellonian University, Krakow, Poland. 4. Department of Cardiac and Vacsular Surgery, Medical University of Gdansk, Gdansk, Poland. 5. Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas, Kansas City, Missouri, USA.
Abstract
BACKGROUND: Concomitant diabetes mellitus (DM) in atrial fibrillation (AF) may increase the risk of thromboembolism. Left atrial appendage occlusion (LAAO) is an alternative treatment in AF patients in whom antithrombotic therapy is ineffective or contraindicated. The aim of this study was to evaluate the long-term efficacy of LAAO in DM patients with AF. METHODS: A retrospective study was conducted in 139 patients who had undergone LAAO and were categorized into two groups: 28 patients with DM and 111 patients without DM. Overall, the follow-up period was 530 patient-years. RESULTS: Mean CHADS2 and CHA2 DS2 -VASc scores were higher in patients with than without DM (2.6 vs 1.7 [P < 0.001] and 3.5 vs 2.8 [P = 0.056], respectively). There were no significant differences between the two groups in terms of HAS-BLED scores and other patient factors (sex, age, heart failure, hypertension, previous stroke or transient ischemic attack, peripheral vascular disease) that may increase the risk of thromboembolism based on CHA2 DS2 -VASc. The mean follow-up period was 51.6 and 50 months in patients with DM and without DM, respectively. Comparing patients with and without DM, there were no significant differences in thromboembolic events (4% vs 1.9%), severe bleeding (0% vs 3.1%), or mortality (4% vs 5.9%). The estimated reductions in thromboembolic and bleeding risk were 77% and 100%, respectively, for patients with DM, compared with 85% and 62%, respectively, for patients without DM. CONCLUSION: The present study indicates that LAAO in AF patients with DM has similar safety endpoints and long-term efficacy as LAAO in patients without DM.
BACKGROUND: Concomitant diabetes mellitus (DM) in atrial fibrillation (AF) may increase the risk of thromboembolism. Left atrial appendage occlusion (LAAO) is an alternative treatment in AFpatients in whom antithrombotic therapy is ineffective or contraindicated. The aim of this study was to evaluate the long-term efficacy of LAAO in DMpatients with AF. METHODS: A retrospective study was conducted in 139 patients who had undergone LAAO and were categorized into two groups: 28 patients with DM and 111 patients without DM. Overall, the follow-up period was 530 patient-years. RESULTS: Mean CHADS2 and CHA2 DS2 -VASc scores were higher in patients with than without DM (2.6 vs 1.7 [P < 0.001] and 3.5 vs 2.8 [P = 0.056], respectively). There were no significant differences between the two groups in terms of HAS-BLED scores and other patient factors (sex, age, heart failure, hypertension, previous stroke or transient ischemic attack, peripheral vascular disease) that may increase the risk of thromboembolism based on CHA2 DS2 -VASc. The mean follow-up period was 51.6 and 50 months in patients with DM and without DM, respectively. Comparing patients with and without DM, there were no significant differences in thromboembolic events (4% vs 1.9%), severe bleeding (0% vs 3.1%), or mortality (4% vs 5.9%). The estimated reductions in thromboembolic and bleeding risk were 77% and 100%, respectively, for patients with DM, compared with 85% and 62%, respectively, for patients without DM. CONCLUSION: The present study indicates that LAAO in AFpatients with DM has similar safety endpoints and long-term efficacy as LAAO in patients without DM.
Authors: Maciej Brzeziński; Aleksandra Sejda; Rafał Pęksa; Maciej Pawlak; Kamil Bury; Zbigniew Adamiak; Maciej Kowalik; Dariusz Jagielak; Krzysztof Bartus; Mateusz K Hołda; Radoslaw Litwinowicz; Jan Rogowski Journal: Ann Biomed Eng Date: 2019-07-15 Impact factor: 3.934