Cardiac amyloidosis and left atrial appendage closure. The CAMYLAAC Study
Ignacio J Amat-Santos 1 , José R Delgado-Arana 2 , Ignacio Cruz-González 3 , Hipólito Gutiérrez 4 , Ignacio García-Bolao 5 , Xavier Millán 6 , Gabriela Tirado-Conte 7 , Juan Miguel Ruiz-Nodar 8 , Mohsen Mohandes 9 , Jorge Palazuelos 10 , Francisco Torres Saura 11 , Raquel Del Valle 12 , Ernesto Valero Picher 13 , Jean Carlos Núñez García 14 , Itziar Gómez 4 , Ramón Albarrán Rincón 5 , Dabit Arzamendi 6 , Luis Nombela-Franco 7 , Liza Korniiko 15 , Alejandro Barrero 15 , Sandra Santos-Martínez 15 , Ana Serrador 4 , J Alberto San Román 4
Introduction and objectives: Transthyretin cardiac amyloidosis (ATTR-CA) patients often have atrial fibrillation and increased bleeding/thrombogenic risks. We aimed to evaluate outcomes of left atrial appendage closure (LAAC) compared with patients without a known diagnosis of CA.
Methods: Comparison at long-term of patients diagnosed with ATTR-CA who underwent LAAC between 2009 and 2020 and those without a known diagnosis of CA.
Results: We studied a total of 1159 patients. Forty patients (3.5%) were diagnosed with ATTR-CA; these patients were older and had more comorbidities, higher HAS-BLED and CHA2DS2-VASc scores, and lower left ventricular function. Successful LAAC was achieved in 1137 patients (98.1%) with no differences between groups. Regarding in-hospital and follow-up complications, there were no differences between the groups in ischemic stroke (5% vs 2.5% in those without a known diagnosis of CA; P = .283), hemorrhagic stroke (2.5% and 0.8% in the control group; P = .284), major or minor bleeding. At the 2-year follow-up, there were no significant differences in mortality (ATTR-CA: 20% vs those without known CA: 13.6%, 0.248); however, the at 5-year follow-up, ATTR-CA patients had higher mortality (40% vs 19.2%; P < .001) but this difference was unrelated to hemorrhagic complications or ischemic stroke.
Conclusions: LAAC could reduce the risk of bleeding complications and ischemic cerebrovascular events without increasing the rate of early or mid-term complications. Although long-term survival was impaired in ATTR-CA patients, it was comparable to that of patients without a known diagnosis of CA at the 2-year follow-up, suggesting that LAAC for patients with ATTR-CA might not be futile.
CITATION Rev Esp Cardiol (Engl Ed). 2022 Aug 4;S1885-5857(22)00208-0. doi: 10.1016/j.rec.2022.08.001