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Favorable neurological outcome after ischemic cerebrovascular events in patients treated with percutaneous left atrial appendage occlusion compared with warfarin

 Oh‐Hyun Lee  ;  Young Dae Kim  ;  Jung‐Sun Kim  ;  Hui‐Nam Pak  ;  Geu‐Ru Hong  ;  Chi Young Shim  ;  Jae‐Sun Uhm  ;  In‐Jeong Cho  ;  Boyoung Joung  ;  Sung‐Jin Hong  ;  Chul‐Min Ahn  ;  Byeong‐Keuk Kim  ;  Young‐Guk Ko  ;  Donghoon Choi  ;  Myeong‐Ki Hong  ;  Cheol‐Woong Yu  ;  Hyun‐Jong Lee  ;  Woong‐Chol Kang  ;  Eun‐Seok Shin  ;  Rak‐kyeong Choi  ;  Do‐Sun Lim  ;  Xavier Freixa  ;  Apostolos Tzikas  ;  Ji Hoe Heo  ;  Yangsoo Jang  ;  Jai‐Wun Park 
 Catheterization and Cardiovascular Interventions, Vol.94(1) : E23-E29, 2019 
Journal Title
Issue Date
anticoagulants ; atrial fibrillation ; left atrial appendage occlusion ; stroke
OBJECTIVES: This study sought to investigate neurological disability after ischemic cerebrovascular events in patients treated with left atrial appendage (LAA) occlusion compared with those on warfarin.

BACKGROUND: Prior studies demonstrated that cerebrovascular events after LAA occlusion in patients with nonvalvular atrial fibrillation (NVAF) is largely nondisabling.

METHODS: From the 1,189 patients in the Korean LAA Occlusion and European Amplatzer Cardiac Plug Multi-Center Registry, 24 patients who experienced ischemic cerebrovascular events after LAA occlusion were enrolled. The neurological outcomes were compared with those in 68 patients who experienced an ischemic cerebrovascular event while on warfarin (Yonsei Stroke Registry). A modified Rankin scale (mRS) score of 3-6 categorized the cerebrovascular event as disabling. The mRS at discharge and at 3 and 12 months postcerebrovascular event in the two groups was compared.

RESULTS: The percentages of disabling cerebrovascular events were 37.5% and 58.8% at discharge (P = 0.07), 20.8% and 42.6% at 3 months (P = 0.08), and 12.5% and 39.7% at 12 months (P = 0.02) in the LAA occlusion and warfarin groups, respectively. The mRS was significantly lower in the LAA occlusion group at discharge and at 3 months (P < 0.01) and 12 months (P < 0.01) postcerebrovascular event despite no significant difference in mRS before cerebrovascular events (P = 0.98). Patients in the LAA occlusion group demonstrated a significant reduction in mRS between discharge and 12 months (P < 0.01), unlike patients in the warfarin group (P = 0.10).

CONCLUSIONS: Ischemic cerebrovascular events in patients who previously underwent percutaneous LAA occlusion for NVAF were more favorable than in patients on warfarin.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Kim, Byeong Keuk(김병극) ORCID logo https://orcid.org/0000-0003-2493-066X
Kim, Young Dae(김영대) ORCID logo https://orcid.org/0000-0001-5750-2616
Kim, Jung Sun(김중선) ORCID logo https://orcid.org/0000-0003-2263-3274
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Shim, Chi Young(심지영) ORCID logo https://orcid.org/0000-0002-6136-0136
Ahn, Chul-Min(안철민) ORCID logo https://orcid.org/0000-0002-7071-4370
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Lee, Oh Hyun(이오현) ORCID logo https://orcid.org/0000-0001-7070-7720
Jang, Yang Soo(장양수) ORCID logo https://orcid.org/0000-0002-2169-3112
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
Cho, In Jeong(조인정)
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
Hong, Geu Ru(홍그루) ORCID logo https://orcid.org/0000-0003-4981-3304
Hong, Myeong Ki(홍명기) ORCID logo https://orcid.org/0000-0002-2090-2031
Hong, Sung Jin(홍성진) ORCID logo https://orcid.org/0000-0003-4893-039X
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