Stroke Mechanism and Severity After Left Atrial Appendage Occlusion: Insights From the LAAOS III Randomized Clinical Trial

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F27661989%3A_____%2F26%3A10003308" target="_blank" >RIV/27661989:_____/26:10003308 - isvavai.cz</a>

Výsledek na webu

<a href="https://jamanetwork.com/journals/jamaneurology/fullarticle/2841567" target="_blank" >https://jamanetwork.com/journals/jamaneurology/fullarticle/2841567</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1001/jamaneurol.2025.4478" target="_blank" >10.1001/jamaneurol.2025.4478</a>

Jazyk výsledku

angličtina

Název v původním jazyce

Stroke Mechanism and Severity After Left Atrial Appendage Occlusion: Insights From the LAAOS III Randomized Clinical Trial

Popis výsledku v původním jazyce

This secondary analysis of the Left Atrial Appendage Occlusion Study III (LAAOS III) randomized clinical trial investigates the impact of LAAO on ischemic stroke subtype and outcome.QuestionAre ischemic stroke events after surgical occlusion of the left atrial appendage (LAAO) during cardiac surgery for patients with known history of atrial fibrillation (AF) of milder severity and less likely to be cardioembolic compared with ischemic stroke events occurring in individuals with AF and without LAAO?FindingsThis post hoc exploratory analysis of the Left Atrial Appendage Occlusion Study III (LAAOS III) trial, which randomized 4811 participants with a history of atrial fibrillation undergoing cardiac surgery to receive surgical LAAO or no LAAO, found that LAAO reduced the mortality and disability from ischemic stroke and the proportion of cardioembolic strokes.MeaningStudy findings complement the reduction in stroke occurrence observed in the primary analysis of the LAAOS III trial and further highlight the benefit of LAAO in stroke prevention among patients with AF undergoing cardiac surgery.ImportanceIn the Left Atrial Appendage Occlusion Study III (LAAOS III), surgical occlusion of the LAA during cardiac surgery for patients with known history of atrial fibrillation (AF) substantially reduced the risk of stroke.ObjectiveTo assess the impact of LAAO on ischemic stroke subtype and outcome.Design, Setting, and ParticipantsThis was a post hoc exploratory analysis of the LAAOS III randomized clinical trial. Data were adjudicated from June 28, 2023, to November 29, 2023, and the main analyses took place from December 18, 2023, to April 29, 2024. The LAAOS III trial recruited participants from 105 centers in 27 countries between July 2012 and October 2018. Patients with AF and a CHA2DS2-VASc score of at least 2 undergoing cardiac surgery for other indications were included in the analysis.InterventionsSurgical LAAO plus standard care vs standard care alone.Main Outcomes and MeasuresFor strokes occurring during the trial, the functional outcome as measured by the modified Rankin Scale (mRS) score at day 7 or discharge, mortality, the presence of cortical infarcts, and the occurrence of infarcts of presumed cardioembolic origin were examined.ResultsOf 4811 participants in the LAAOS III trial followed up for 3.8 years, 273 had a first ischemic stroke. The mean (SD) age of participants at the time of the first ischemic stroke was 75 (7) years, 104 were female (38%), and 169 were male (62%). Participants allocated to receive LAAO had reduced (common odds ratio [OR], 0.80; 95% CI, 0.65-0.99) mRS scores at 7 days or discharge and a lower risk for mortality at 30 days (16.5% vs 20.1%; hazard ratio [HR], 0.55; 95% CI, 0.31-0.97) after a stroke event. Participants allocated to LAAO had fewer cortical infarcts on neuroimaging (46.2% vs 61.3%; difference in proportions: -15.2%; 95% CI, -26.7% to -3.7%), as well as a lower proportion of ischemic strokes of presumed cardioembolic etiology when compared with ischemic strokes in the no-LAAO group (42.9% vs 57.9%; difference in proportions: -15.1%; 95% CI, -26.5% to -3.7%).Conclusions and RelevanceThis study found that LAAO in patients with AF undergoing cardiac surgery was associated with a decreased risk of presumed cardioembolic stroke, reduced disability, and mortality from stroke. These findings underscore the benefit of LAAO for patients with AF undergoing cardiac surgery.Trial RegistrationClinicalTrials.gov Identifier: NCT01561651

Název v anglickém jazyce

Stroke Mechanism and Severity After Left Atrial Appendage Occlusion: Insights From the LAAOS III Randomized Clinical Trial

Popis výsledku anglicky

This secondary analysis of the Left Atrial Appendage Occlusion Study III (LAAOS III) randomized clinical trial investigates the impact of LAAO on ischemic stroke subtype and outcome.QuestionAre ischemic stroke events after surgical occlusion of the left atrial appendage (LAAO) during cardiac surgery for patients with known history of atrial fibrillation (AF) of milder severity and less likely to be cardioembolic compared with ischemic stroke events occurring in individuals with AF and without LAAO?FindingsThis post hoc exploratory analysis of the Left Atrial Appendage Occlusion Study III (LAAOS III) trial, which randomized 4811 participants with a history of atrial fibrillation undergoing cardiac surgery to receive surgical LAAO or no LAAO, found that LAAO reduced the mortality and disability from ischemic stroke and the proportion of cardioembolic strokes.MeaningStudy findings complement the reduction in stroke occurrence observed in the primary analysis of the LAAOS III trial and further highlight the benefit of LAAO in stroke prevention among patients with AF undergoing cardiac surgery.ImportanceIn the Left Atrial Appendage Occlusion Study III (LAAOS III), surgical occlusion of the LAA during cardiac surgery for patients with known history of atrial fibrillation (AF) substantially reduced the risk of stroke.ObjectiveTo assess the impact of LAAO on ischemic stroke subtype and outcome.Design, Setting, and ParticipantsThis was a post hoc exploratory analysis of the LAAOS III randomized clinical trial. Data were adjudicated from June 28, 2023, to November 29, 2023, and the main analyses took place from December 18, 2023, to April 29, 2024. The LAAOS III trial recruited participants from 105 centers in 27 countries between July 2012 and October 2018. Patients with AF and a CHA2DS2-VASc score of at least 2 undergoing cardiac surgery for other indications were included in the analysis.InterventionsSurgical LAAO plus standard care vs standard care alone.Main Outcomes and MeasuresFor strokes occurring during the trial, the functional outcome as measured by the modified Rankin Scale (mRS) score at day 7 or discharge, mortality, the presence of cortical infarcts, and the occurrence of infarcts of presumed cardioembolic origin were examined.ResultsOf 4811 participants in the LAAOS III trial followed up for 3.8 years, 273 had a first ischemic stroke. The mean (SD) age of participants at the time of the first ischemic stroke was 75 (7) years, 104 were female (38%), and 169 were male (62%). Participants allocated to receive LAAO had reduced (common odds ratio [OR], 0.80; 95% CI, 0.65-0.99) mRS scores at 7 days or discharge and a lower risk for mortality at 30 days (16.5% vs 20.1%; hazard ratio [HR], 0.55; 95% CI, 0.31-0.97) after a stroke event. Participants allocated to LAAO had fewer cortical infarcts on neuroimaging (46.2% vs 61.3%; difference in proportions: -15.2%; 95% CI, -26.7% to -3.7%), as well as a lower proportion of ischemic strokes of presumed cardioembolic etiology when compared with ischemic strokes in the no-LAAO group (42.9% vs 57.9%; difference in proportions: -15.1%; 95% CI, -26.5% to -3.7%).Conclusions and RelevanceThis study found that LAAO in patients with AF undergoing cardiac surgery was associated with a decreased risk of presumed cardioembolic stroke, reduced disability, and mortality from stroke. These findings underscore the benefit of LAAO for patients with AF undergoing cardiac surgery.Trial RegistrationClinicalTrials.gov Identifier: NCT01561651

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30210 - Clinical neurology

Projekt

—

Návaznosti

V - Vyzkumna aktivita podporovana z jinych verejnych zdroju

Rok uplatnění

2026

Kód důvěrnosti údajů

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

Název periodika

JAMA Neurology

ISSN

2168-6149

e-ISSN

2168-6157

Svazek periodika

83

Číslo periodika v rámci svazku

1

Stát vydavatele periodika

US - Spojené státy americké

Počet stran výsledku

7

Strana od-do

76-82

Kód UT WoS článku

001627201500001

EID výsledku v databázi Scopus

—