The feasibility and safety of "one-stop" left atrial appendage closure and percutaneous coronary intervention in atrial fibrillation patients with significant coronary artery disease (PCI-LAAC study)

Yubin Wang; Dewei Wu; Juan Ma; Xiangping Liu; Haitong Zhang; Chak-Yu So; Yin-Yat Lam; Bincheng Wang; Jiande Wang; Hongliang Zhang; Moyang Wang; Guangyuan Song; Yongjian Wu

The feasibility and safety of "one-stop" left atrial appendage closure and percutaneous coronary intervention in atrial fibrillation patients with significant coronary artery disease (PCI-LAAC study)

Am J Cardiovasc Dis. 2021 Oct 25;11(5):679-687. eCollection 2021.

Authors

Yubin Wang^{1

2}, Dewei Wu², Juan Ma³, Xiangping Liu⁴, Haitong Zhang¹, Chak-Yu So⁵, Yin-Yat Lam⁶, Bincheng Wang¹, Jiande Wang¹, Hongliang Zhang¹, Moyang Wang¹, Guangyuan Song⁷, Yongjian Wu¹

Affiliations

¹ Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College Beijing, China.
² Department of Cardiology, Xuanwu Hospital, Capital Medical University Beijing 100053, China.
³ Department of Teaching Research Supervision, Haidian District Health School Beijing 100192, China.
⁴ Department of Cardiology, Yiyuan People's Hospital Shandong Province 256100, China.
⁵ Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong Hong Kong SAR, China.
⁶ Hong Kong Asian Heart Center, Canossa Hospital Hong Kong SAR, China.
⁷ Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University Beijing, China.

PMID: 34849300
PMCID: PMC8611261

Abstract

Background: The anti-thrombotic strategy for patients with atrial fibrillation (AF) who have undergone percutaneous coronary intervention (PCI) for coronary artery disease (CAD) is a common and difficult challenge. This pilot study aimed to assess the feasibility and safety of "one-stop" left atrial appendage closure (LAAC) combined with PCI as an alternative stroke prophylaxis strategy.

Methods: From March 2017 to October 2019, AF patients with elevated bleeding risk and significant stable CAD requiring PCI were recruited to undergo LAAC as alternative stroke prophylaxis in Fuwai Hospital, Beijing, China. LAAC was performed either in the same setting with PCI (i.e. "one-stop" LAAC/PCI), or as staged procedure after PCI. Dual antiplatelet therapy was given for all patients after LAAC. Peri-procedural and intermediate-term clinical outcomes were assessed through hospital clinical records review and standardized telephone interviews.

Results: A total of 24 patients were recruited including 13 (54.2%) underwent stage procedure and 11 (45.8%) underwent "one-stop" procedure respectively. The mean CHA₂DS₂-VASc and HAS-BLED scores were 4.5±1.4 and 3 (IQR 3,4) respectively. Six patients (46.1%) in the staged procedure cohort were treated with triple anti-thrombotic following PCI, with 2 developed minor bleeding before LAAC. One patient ("one-stop" cohort) had gastrointestinal bleeding 1 day after procedure. Otherwise, there was no device related complication or peri-procedural stroke/myocardial infarction. After a mean 19±5.4 months follow-up, there was no death, myocardial infarction, stroke and systemic embolization detected.

Conclusions: In this pilot study, "one-stop" LAAC with PCI was shown to be efficacious with no stroke, MI, VARC-2 major bleeding or CV death reported over a mean follow-up of 19 months, and safe with no major peri-procedural bleeding or device related complications.

Keywords: Atrial fibrillation (AF); coronary artery disease (CAD); left atrial appendage closure (LAAC); oral anticoagulants (OAC); percutaneous coronary Intervention (PCI).