NYMC Faculty Publications

Cerebrovascular Accidents and Mortality Following Left Atrial Appendage Occlusion in Patients With Moderate and Severe Chronic Renal Impairment: A Comprehensive Meta-Analysis

Author Type(s)

Faculty

DOI

10.1016/S0735-1097(24)03132-2

Journal Title

Journal of the American College of Cardiology

First Page

1142

Document Type

Article

Publication Date

4-2-2024

Department

Medicine

Disciplines

Medicine and Health Sciences

Abstract

Background

This study aims to assess mortality and cerebrovascular events post LAAO in patients with different stages of chronic renal disease.

Methods

We conducted a systematic review following PRISMA guidelines. We searched PubMed, Scopus, and Web of Science for relevant citations. Two independent reviewers screened and extracted data. Eligible studies compared post-LAAO mortality and stroke between CKD and non-CKD patients, with a meta-analysis planned to assess outcomes in ESRD. Statistical analyses were performed using R software.

Results

In total, 13 studies involving 56,041 patients were analyzed. Post-LAAO, patients with CKD had a higher mortality rate (OR=2.46 [2.00-3.03], I2=0%). However, there was no significant difference in stroke/TIA incidence between the groups (OR=0.80 [0.57-1.12], I2=30%). ESRD was associated with significantly higher odds of mortality (OR=3.19 [1.22-8.38], I2=82%) and stroke/TIA (OR=4.17 [2.97-5.85], I2=0%) following LAAO. No publication bias was detected based on Egger's regression test.

Conclusion

Our study suggests that LAAO may have similar efficacy in individuals with or without CKD. However, the mortality rate is higher, especially in patients with end-stage renal disease (ESRD). This underscores the need for well-designed clinical trials to compare treatment strategies, such as novel anticoagulants and LAAO, for managing atrial fibrillation in severe CKD.

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