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Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke

The result's identifiers

  • Result code in IS VaVaI

    <a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00023001%3A_____%2F21%3A00081023" target="_blank" >RIV/00023001:_____/21:00081023 - isvavai.cz</a>

  • Alternative codes found

    RIV/00209775:_____/21:N0000028

  • Result on the web

    <a href="https://www.nejm.org/doi/pdf/10.1056/NEJMoa2101897?listPDF=true" target="_blank" >https://www.nejm.org/doi/pdf/10.1056/NEJMoa2101897?listPDF=true</a>

  • DOI - Digital Object Identifier

    <a href="http://dx.doi.org/10.1056/NEJMoa2101897" target="_blank" >10.1056/NEJMoa2101897</a>

Alternative languages

  • Result language

    angličtina

  • Original language name

    Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke

  • Original language description

    BACKGROUND Surgical occlusion of the left atrial appendage has been hypothesized to prevent ischemic stroke in patients with atrial fibrillation, but this has not been proved. The procedure can be performed during cardiac surgery undertaken for other reasons. METHODS We conducted a multicenter, randomized trial involving participants with atrial fibrillation and a CHA(2)DS(2)-VASc score of at least 2 (on a scale from 0 to 9, with higher scores indicating greater risk of stroke) who were scheduled to undergo cardiac surgery for another indication. The participants were randomly assigned to undergo or not undergo occlusion of the left atrial appendage during surgery; all the participants were expected to receive usual care, including oral anticoagulation, during follow-up. The primary outcome was the occurrence of ischemic stroke (including transient ischemic attack with positive neuroimaging) or systemic embolism. The participants, research personnel, and primary care physicians (other than the surgeons) were unaware of the trial-group assignments. RESULTS The primary analysis population included 2379 participants in the occlusion group and 2391 in the no-occlusion group, with a mean age of 71 years and a mean CHA(2)DS(2)-VASc score of 4.2. The participants were followed for a mean of 3.8 years. A total of 92.1% of the participants received the assigned procedure, and at 3 years, 76.8% of the participants continued to receive oral anticoagulation. Stroke or systemic embolism occurred in 114 participants (4.8%) in the occlusion group and in 168 (7.0%) in the no-occlusion group (hazard ratio, 0.67; 95% confidence interval, 0.53 to 0.85; P=0.001). The incidence of perioperative bleeding, heart failure, or death did not differ significantly between the trial groups. CONCLUSIONS Among participants with atrial fibrillation who had undergone cardiac surgery, most of whom continued to receive ongoing antithrombotic therapy, the risk of ischemic stroke or systemic embolism was lower with concomitant left atrial appendage occlusion performed during the surgery than without it.

  • Czech name

  • Czech description

Classification

  • Type

    J<sub>imp</sub> - Article in a specialist periodical, which is included in the Web of Science database

  • CEP classification

  • OECD FORD branch

    30212 - Surgery

Result continuities

  • Project

  • Continuities

    N - Vyzkumna aktivita podporovana z neverejnych zdroju

Others

  • Publication year

    2021

  • Confidentiality

    S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Data specific for result type

  • Name of the periodical

    New England journal of medicine

  • ISSN

    0028-4793

  • e-ISSN

  • Volume of the periodical

    384

  • Issue of the periodical within the volume

    22

  • Country of publishing house

    US - UNITED STATES

  • Number of pages

    11

  • Pages from-to

    2081-2091

  • UT code for WoS article

    000652582300001

  • EID of the result in the Scopus database

    2-s2.0-85106758285