RESULTS: The EWOLUTION registry is a real-world cohort comprising 1020 patients that underwent LAAO. Endpoint definitions were pre-specified, and death was categorized as cardiovascular, non-cardiovascular, or unknown origin. Mortality rates were calculated from Kaplan-Meier estimates. Baseline characteristics significantly associated with death in univariate Cox regression analysis were incorporated into the multivariate analysis. All multivariate predictors were included in a risk model. Two-year mortality rate was 16.4% [confidence interval (CI): 14.0-18.7%], with 50% of patients dying from a non-cardiovascular cause. Multivariate baseline predictors of 2-year mortality included age [hazard ratio (HR) 1.05, CI: 1.03-1.08, per year increase], heart failure (HR 1.73, CI: 1.24-2.41), vascular disease (HR 1.47, CI: 1.05-2.05), valvular disease (HR 1.63, CI: 1.15-2.33), abnormal liver function (HR 1.80, CI: 1.02-3.17), and abnormal renal function (HR 1.58, CI: 1.10-2.27). Mortality rate exhibited a gradual rise as the number of risk factors increased, reaching 46.1% in patients presenting with five or six risk factors.
CONCLUSIONS: One in six patients died within 2 years after LAAO. We identified six independent predictors of mortality. When combined, this model showed a gradual increase in mortality rate with a growing number of risk factors, which may guide appropriate patient selection for LAAO.
BACKGROUND: The original EWOLUTION registry was registered at clinicaltrials.gov under identifier NCT01972282.
结果:EWOLUTION注册是一个真实世界的队列,包括1020名接受LAAO的患者。端点定义已预先指定,死亡被归类为心血管疾病,非心血管疾病,或者来历不明。根据Kaplan-Meier估计计算死亡率。单变量Cox回归分析中与死亡显著相关的基线特征被纳入多变量分析。所有多变量预测因子都包含在风险模型中。两年死亡率为16.4%[置信区间(CI):14.0-18.7%],50%的患者死于非心血管原因。2年死亡率的多变量基线预测因素包括年龄[风险比(HR)1.05,CI:1.03-1.08,每年增加],心力衰竭(HR1.73,CI:1.24-2.41),血管疾病(HR1.47,CI:1.05-2.05),瓣膜疾病(HR1.63,CI:1.15-2.33),肝功能异常(HR1.80,CI:1.02-3.17),肾功能异常(HR1.58,CI:1.10-2.27)。随着危险因素的增加,死亡率逐渐上升,在存在5或6个危险因素的患者中达到46.1%。
结论:六分之一的患者在LAAO后2年内死亡。我们确定了六个独立的死亡率预测因子。当组合时,该模型显示,随着危险因素的增加,死亡率逐渐增加,这可以指导LAAO的适当患者选择。
背景:原始的EWOLUTION注册表在clinicaltrials.gov注册,其标识符为NCT01972282。