SPC365

Left atrial appendage occlusion in patients with chronic kidney disease or cancer: an intelligent choice?

Session: Posters (Sessão 4 - Écran 7) - Intervenção Cardíaca Coronária e Estrutural 2 - Foco na Doença Estrutural Não Valvular
Speaker: Ana Margarida Martins

Congress: CPC 2022
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Ana Margarida Martins; Pedro Silvério António; Sara Couto Pereira; Pedro Alves da Silva; Beatriz Valente Silva; Joana Brito; Catarina Oliveira; Ana Beatriz Garcia; Catarina Gregório; João Santos Fonseca; Ana Rita Francisco; João Silva Marques; Miguel Nobre Menezes; Fausto j. Pinto; Pedro Cardoso

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> Role of oral anticoagulation (OAC) is well established in preventing stroke and embolic events. However, evidence regarding OAC in this setting is limited in cancer patients (pts). Pts with chronic kidney disease (CKD) are also challenging and evidence is limited for those with CrCl&lt;30mL/min, as major clinical trials excluded them. Left atrial appendage occlusion (LAAO) emerged as an alternative to OAC in pts where it may be challenging and thus might represent a good option. However, data regarding LAAO for such cases is also scarce.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Objective:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> To evaluate LAAO safety and effectiveness in cancer and CKD pts during a 12-year period.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">From a general cohort pts who underwent LAAO, two subgroups were analysed: (1)pts with history of current or past cancer; (2)CKD, defined as CrCl &le;60 ml/min. Pts with CrCl&lt;30 mL/min were also analyzed. Clinical and demographic characteristics, CHADsVASc and HASBLED score, procedure characteristics, complications and antithrombotic therapy were gathered. Efficacy endpoint was defined as stroke or embolic event and safety endpoint as major bleeding according to HAS-BLED criteria. For statistical analysis, we used Chi-Square test and Kaplan-Meier survival curves.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> A total of 139 procedures (59.6% male, mean age 74&plusmn;8yrs) were analysed. Mean CHA</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sub>2</sub></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Ds</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sub>2</sub></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">VASc and HAS-BLED score was 4.2&plusmn;1.3 and 3.4&plusmn;0.9, respectively. CKD was present in 38.8% of pts. The efficacy endpoint occurred more frequently than in non-CKD pts, but the difference was not statistically significant (5.5% vs 1.3%, p=0.103; LogRank 2.655). Considering those with CrCl&lt;30 mL/min (7.9% of the total population), there were also no significant differences when compared to the remaining population regarding the efficacy endpoint (3.1% vs 0%, p =0.598; LogRank 0.278).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Regarding safety endpoint, there were also no differences between CKD pts and the remainder population (14.8% vs 14.3%, p= p=0.933). 18.7% had cancer, with hematologic (26%), gastrointestinal (26%) and prostatic (17.4%) accounting for the most common primary tumor locations. There was no statistically significant difference between groups, both regarding efficacy (cancer 0%, control 1.3%, p=0.342) and safety endpoints (cancer 21.7%, control 14.3%, p=0.373).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> LAAO was an effective and safe strategy in CKD (including those with severe CKD) or cancer populations. Considering the added problems and limited evidence regarding OAC in these pts, LAAO may be considered in such cases.</span></span></span></p>

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