Cierre de la orejuela izquierda frente a anticoagulantes orales en FA e implante de stents coronarios. Registro DESAFIO

  1. José Ramón López Mínguez 1
  2. Estrella Suárez Corchuelo 1
  3. Sergio López Tejero 2
  4. Luis Nombela Franco 3
  5. Xavier Freixa 4
  6. Guillermo Bastos Fernández 5
  7. Xavier Millan 6
  8. Raúl Moreno Gómez 7
  9. José Antonio Fernández Díaz 8
  10. Ignacio Amat Santos 9
  11. Tomás Benito González 10
  12. Fernando Alfonso Manterola 11
  13. Pablo Salinas Sanguino 3
  14. Pedro L. Cepas Guillén 4
  15. Dabit Arzamendi 6
  16. Ignacio Cruz González 2
  17. Juan Manuel Nogales Asensio 1
  1. 1 Sección de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de Badajoz, Badajoz, España
  2. 2 Sección de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
  3. 3 Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España
  4. 4 Sección de Cardiología Intervencionista, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos Madrid, España
  5. 5 Sección de Cardiología Intervencionista, Servicio de Cardiología, Hospital Clínico de Barcelona, Barcelona, España
  6. 6 Sección de Cardiología Intervencionista, Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
  7. 7 Sección de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, España
  8. 8 Sección de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de La Paz, IdiPAZ, Madrid, España
  9. 9 Sección de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de Puerta de Hierro, Majadahonda, Madrid, España
  10. 10 Sección de Cardiología Intervencionista, Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, España
  11. 11 Sección de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de León, León, España
REC: Interventional Cardiology

ISSN: 2604-7276 2604-7306

Year of publication: 2023

Volume: 5

Issue: 4

Pages: 287-296

Type: Article

DOI: 10.24875/RECIC.M23000386 DIALNET GOOGLE SCHOLAR lock_openDialnet editor

More publications in: REC: Interventional Cardiology


Introduction and objectives: The treatment of patients with non-valvular atrial fibrillation (NVAF) who need coronary stenting is challenging. The objective of the study was to determine whether left atrial appendage occlusion (LAAO) could be a feasible option and benefit these patients. To this end, we studied the impact of LAAO plus antiplatelet drugs vs oral anticoagulants (OAC) (including direct OAC) plus antiplatelet drugs in these patients’ long-term outcomes. Methods: The results of 207 consecutive patients with NVAF who underwent coronary stenting were analyzed. A total of 146 patients were treated with OAC (75 with acenocoumarol, 71 with direct OAC) while 61 underwent LAAO. The median follow-up was 35 months. Patients also received antiplatelet therapy as prescribed by their cardiologist. The study received the proper ethical oversight. Results: Age (mean 75.7 years), and the past medical history of stroke were similar in both groups. However, the LAAO group had more unfavorable characteristics (history of coronary artery disease [CHA2DS2-VASc], and significant bleeding [BARC ≥ 2] and HAS-BLED). The occurrence of major adverse events (death, stroke/transient ischemic events, major bleeding) and major cardiovascular events (cardiac death, stroke/transient ischemic attack, and myocardial infarction) were significantly higher in the OAC group compared to the LAAO group: 19.75% vs 9.06% (HR, 2.18; P = .008) and 6.37% vs 1.91% (HR, 3.34; P = .037), respectively. Conclusions: In patients with NVAF undergoing coronary stenting, LAAO plus antiplatelet therapy produced better long-term outcomes compared to treatment with OAC plus antiplatelet therapy despite the unfavorable baseline characteristics of the LAAO group.

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