Percutaneous left atrial appendage occlusion in nonvalvular atrial fibrillation patients with coronary heart disease

Abstract Purpose To evaluate the 12-month outcomes of the percutaneous left atrial appendage occlusion (LAAO) procedure in nonvalvular atrial fibrillation (NVAF) patients with coronary heart disease (CAD). Materials and Methods 51 NVAF patients were consecutively accepted LAAO between June 2015 and July 2017. Patients were devided in two groups: 15 with CAD and 36 without CAD. All patients were followed up at 1st, 3rd, 6th, and 12th month after discharge with transesophageal echocardiography (TEE) examination repeated at the same time. Results Among these 51 patients (average age 64.4±10.0, 33.3% female), the procedural success rate was 98% (50/51). During 12-month follow-up, there were no hemorrhagic stroke or major bleeding. The risk of thromboembolism based on CHA2DS2-VASc score (3.1±1.6 vs. 5.2±1.1, P<0.001) and the risk of hemorrhage based on HAS-BLED score (2.2±1.2 vs. 3.1±1.0, P=0.009) in CAD group were significantly higher. The incidence of end-point events had no statistical difference between CAD and non-CAD. Compared with CAD patients who accepted long-term antithrombotic medication, there was no obvious difference in stroke rate and mortality in CAD accepted LAAO group, whereas a further reduction of hemorrhage (n=5/20% vs. n=0, P=0.039) was shown. A significant correlation (P<0.001, r=0.580) was detected between moderate or severe left atrial spontaneous echo contrast (LASEC) and the composite end point events. Conclusion There are similar safety and effectiveness for LAAO procedure in NVAF patients with CAD and without CAD under new oral anticoagulants applied post-implantation anticoagulation strategy. Meanwhile, LASEC is a predictive factor of LAAO in NVAF patients combined CAD.