SPC365

Left atrial appendage occlusion in CKD: A Safe Option for Stroke Prevention or Just a Pipe Dream?

Session: SESSÃO DE POSTERS 29 - FIBRILHAÇÃO AURICULAR: DA PREVENÇÃO À INTERVENÇÃO
Speaker: Francisco Salvaterra

Congress: CPC 2025
Topic: K. Cardiovascular Disease In Special Populations
Theme: 30. Cardiovascular Disease in Special Populations
Subtheme: 30.9 Renal Failure and Cardiovascular Disease
Session Type: Cartazes
FP Number: ---
Authors: Francisco Salvaterra; Miguel Nobre Menezes; Catarina Gregório; Ana Abrantes; Ana Rita Francisco; Catarina Oliveira; Tiago Rodrigues; João Silva Marques; Gustavo Lima da Silva; João de Sousa; Pedro Cardoso; Fausto J. Pinto

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,sans-serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Introduction</span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif">: </span></span>Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist, both increasing thromboembolism risk. While non-vitamin K oral anticoagulants (NOACs) are preferred over vitamin K antagonists (VKAs), their safety and efficacy in severe CKD are less established, and are&nbsp;often used off-label. Left atrial appendage occlusion (LAAO) may offer a viable alternative for stroke prevention in these patients.</span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,sans-serif"><span style="font-family:&quot;Calibri&quot;,sans-serif"><strong>Aim</strong>: To evaluate the efficacy and&nbsp;safety of LAAO in severe CKD patients with AF. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,sans-serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Methods</span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif">: A single-center study was conducted on consecutive patients undergoing percutaneous LAAO. Procedure details, complications, CHA2DS2-VASc and HAS-BLED scores were recorded. Efficacy was defined as the absence of stroke, cardiovascular death, or systemic embolism, while safety endpoints included procedural complications and major bleeding events. Severe CKD was defined as an eGFR&lt;30ml/min/1.73 m&sup2;, using the CKD-Epidemiology Collaboration equation. Kaplan-Meier survival analysis was performed to evaluate the efficacy and safety endpoints.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,sans-serif">&nbsp;<strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Results</span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif">: A total of 215 patients undergoing LAAO were included (mean age 74.5&plusmn;8.1 years, 63.7% male), with 25 patients having CKD. CKD patients had a significantly higher history of stroke (75% vs. 5%, p=0.03), acute myocardial infarction (35% vs. 10%, p=0.015), and peripheral arterial disease (14% vs. 5%, p=0.04) compared to non-CKD patients. There were no differences regarding age, sex, CHA2DS2-VASc or HAS-BLED scores between groups. The main reason for referral to LAAO in CKD patients was gastrointestinal bleeding (62% vs. 16%, p=0.003), while ischemic or hemorrhagic stroke under OAC was the primary indication in non-CKD patients (40% vs. 0%, p=0.005). No differences were found in procedure time, type of device implanted, or procedural success.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:16px">After LAAO, most CKD patients received&nbsp;mono or dual antiplatelet therapy, while non-CKD patients were more commonly treated with VKA and aspirin (p&lt;0.001).&nbsp;<span style="font-family:Arial,sans-serif"><span style="font-family:&quot;Calibri&quot;,sans-serif">The presence of CKD was not associated with acute procedural complications, with only one minor vascular access-related complication observed (1.6% vs. 4.2%, p=NS).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,sans-serif"><span style="font-family:&quot;Calibri&quot;,sans-serif">Additionally, no major bleeding events were observed in CKD patients during follow-up (3 minor bleeds in CKD vs. 3 major bleeds and 25 minor bleeds in non-CKD patients, p=NS). During a mean follow-up of 18.3&plusmn;4.2 months, there were 7 strokes (1 CKD patient, 6 non-CKD patients), 1 systemic embolism, and 5 cardiovascular deaths, none of which occurred in CKD patients. No statistically significant differences were found between CKD and non-CKD patients regarding either safety (LogRank p=0.177) or efficacy endpoints (LogRank p=0.054</span><span style="font-family:&quot;Calibri&quot;,sans-serif">). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,sans-serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Conclusion</span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif">: In this cohort, percutaneous LAAO demonstrated similar safety and efficacy outcomes in both CKD and non-CKD patients. Therefore, LAAO should be considered as a therapeutic strategy for stroke prevention in CKD patients.</span></span></span></p>