Left atrial appendage occlusion for stroke prevention in diabetes mellitus patients with atrial fibrillation: Long-term results
合并心房颤动的糖尿病患者通过左心耳封堵术预防脑卒中:长期结果
Abstract
enBackground
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 CHA2DS2-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 CHA2DS2-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.
Abstract
zh摘要
背景
糖尿病合并心房颤动(atrial fibrillation,AF)可能会导致血栓栓塞症的风险增加。对于AF患者, 如果抗栓治疗无效或者有禁忌, 另外还有一种治疗方法就是封堵左心耳(Left atrial appendage occlusion,LAAO)。本研究旨在糖尿病合并AF的患者中评估LAAO的长期疗效。
方法
这是一项在139例曾经接受过LAAO治疗的患者中进行的回顾性研究, 将患者分为两组:合并糖尿病组有28例患者, 未合并糖尿病组有111例患者。总共随访时间为530患者年。
结果
合并糖尿病组患者的平均CHADS2与CHA2DS2-VASc评分显著高于未合并DM组患者(分别为2.6与1.7[P < 0.001]以及3.5与2.8[P = 0.056])。两组之间的HAS-BLED评分以及基于CHA2DS2-VASc评估的其他可以导致血栓栓塞症风险增加的患者因素(性别、年龄、心脏衰竭、高血压、既往中风或者短暂性脑缺血发作病史、周围血管疾病)都没有显著性差异。合并与未合并糖尿病组患者的平均随访时间分别为51.6与50个月。合并与未合并糖尿病的患者相比, 血栓栓塞事件(4%与1.9%)、严重出血(0%与3.1%)或者死亡率(4%与5.9%)都没有显著性的差异。对于合并糖尿病的患者, 血栓栓塞事件与出血的风险估计分别减少了77%与100%,而对照的未合并糖尿病的患者分别减少了85%与62%。
结论
当前这项研究结果表明, 合并糖尿病的AF患者接受LAAO治疗后, 其安全性终点以及长期疗效与未合并糖尿病患者的LAAO结果相似。
