左心耳封堵术在非瓣膜性心房颤动合并冠心病患者中的安全性及有效性分析

Safety and efficacy of percutaneous left atrial appendage occlusion in nonvalvular atrial fibrillation patients with coronary heart disease

目的:评估左心耳封堵术在非瓣膜性心房颤动(nonvalvular atrial fibrillation,NVAF)合并冠心病患者中的安全性及有效性。方法:回顾分析在2015年6月—2017年7月在南京医科大学附属南京医院接受左心耳封堵术的NVAF患者51例,将其分为两组:合并冠心病组以及未合并冠心病组,进行食道超声检查及电话随访。同时纳入同期20例接受新型口服抗凝药预防栓塞的NVAF合并冠心病患者为对照。结果:NVAF合并冠心病组(n=15)较未合并冠心病组(n=36)的栓塞及出血风险更高,但随访结果显示两组终点事件无明显差异。与长期接受药物抗凝的冠心病患者相比,接受左心耳封堵术明显降低大出血风险。中度及重度的左房自显影与终点事件密切相关。结论:不论是否合并有冠心病,左心耳封堵术在非瓣膜性心房颤动患者中均可预防栓塞并降低大出血发生。左房自显影是非瓣膜性心房颤动合并冠心病患者左心耳封堵术预后的预测因子。

Objective:This study aims to evaluate the safety and efficiency of the percutaneous left atrial appendage occlusion(LAAO)in nonvalvular atrial fibrillation(NVAF)patients with coronary heart disease(CAD).Methods:Total 51 NVAF patients were consecutively accepted LAAO from June 2015 to July 2017.Patients were divided in two groups:15 with CAD and 36 without CAD.All patients were followed up after discharge with transesophageal echocardiography(TEE)examination.Results:Patients with CAD had higher incidence of hemorrhagic stroke or major bleeding than those without CAD.The incidence of end-point events had no statistical difference between CAD group and non-CAD group.Compared with CAD patients who accepted long-term antithrombotic medication,there was a further reduction of hemorrhage in CAD patients who accepted LAAO group.Moderate or severe left atrial spontaneous echo contrast was correlated with the composite end point events.Conclusion:There are similar safety and effectiveness for LAAO procedure in NVAF patients with or without CAD.Meanwhile,left atrial spontaneous echo contrast is a predictive factor of LAAO in NVAF patients combined CAD.