Detalle Publicación

Cardiac amyloidosis and left atrial appendage closure. The CAMYLAAC study

Autores: Amat-Santos, I. J. (Autor de correspondencia); Delgado-Arana, J. R.; Cruz-Gonzalez, I.; Gutierrez, H.; García Bolao, José Ignacio; Millan, X.; Tirado-Conte, G.; Ruiz-Nodar, J. M.; Mohandes, M.; Palazuelos, J.; Saura, F. T.; Del Valle, R.; Picher, E. V.; Garcia, J. C. N.; Gomez, I.; Rincon, R. A.; Arzamendi, D.; Nombela-Franco, L.; Korniiko, L.; Barrero, A.; Santos-Martinez, S.; Serrador, A.; Roman, J. A. S.
Título de la revista: REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH ED.)
ISSN: 1885-5857
Volumen: 76
Número: 7
Páginas: 503 - 510
Fecha de publicación: 2023
Resumen:
Introduction and objectives: Transthyretin cardiac amyloidosis (ATTR-CA) patients often have atrial fibrillation and increased bleeding/thrombogenic risks. We aimed to evaluate outcomes of left atrial appendage closure (LAAC) compared with patients without a known diagnosis of CA. Methods: Comparison at long-term of patients diagnosed with ATTR-CA who underwent LAAC between 2009 and 2020 and those without a known diagnosis of CA. Results: We studied a total of 1159 patients. Forty patients (3.5%) were diagnosed with ATTR-CA; these patients were older and had more comorbidities, higher HAS-BLED and CHA2DS2-VASc scores, and lower left ventricular function. Successful LAAC was achieved in 1137 patients (98.1%) with no differences between groups. Regarding in-hospital and follow-up complications, there were no differences between the groups in ischemic stroke (5% vs 2.5% in those without a known diagnosis of CA; P=.283), hemorrhagic stroke (2.5% and 0.8% in the control group; P=.284), major or minor bleeding. At the 2-year follow-up, there were no significant differences in mortality (ATTR-CA: 20% vs those without known CA: 13.6%, 0.248); however, the at 5-year follow-up, ATTR-CA patients had higher mortality (40% vs 19.2%; P <.001) but this difference was unrelated to hemorrhagic complications or ischemic stroke. Conclusions: LAAC could reduce the risk of bleeding complications and ischemic cerebrovascular events without increasing the rate of early or mid-term complications. Although long-term survival was impaired in ATTR-CA patients, it was comparable to that of patients without a known diagnosis of CA at the 2-year follow-up, suggesting that LAAC for patients with ATTR-CA might not be futile.
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