Background: Atrial fibrillation (AF) is frequently observed in cancer patients, driven by mutual comorbidities and increasing the risk of thromboembolic events. Impediments can hinder the utilization of anticoagulants among patients with malignancy—drug interactions with chemotherapy, renal dysfunction, drug intolerance, and increased bleeding risk. Left atrial appendage occlusion (LAAO) is an effective and safe non-pharmacological approach to prevent thromboembolic complications when anticoagulants are not suitable. Cancer patients were generally excluded from the original LAAO trials, and current safety and efficacy in cancer patients remain uncertain.Methods: This retrospective study utilized the National Inpatient Sample (NIS) database to analyze in-hospital outcomes of LAAO in US patients with and without cancer between 2016 and 2019. Patient demographics, comorbidities, procedures, and in-hospital outcomes were extracted using ICD-10-CM codes.Results: Among 12,273 hospitalizations for LAAO across the US representing an estimated 61,365 LAAO procedures, 2.2% (1365 cases) were performed in cancer patients. Older age, male gender, chronic kidney disease, prior stroke, and anemia were more prevalent in the cancer group, with 785 (58%) having a solid malignancy and 580 (42%) having a hematologic malignancy. Compared to non-cancer patients, cancer patients exhibited a higher rate of in-hospital complications (8.8% vs. 5.7%;p< 0.001), primarily driven by acute kidney injury (4.4% vs. 2.4%;p= 0.002), acute heart failure (3.7% vs. 2.6%;p= 0.012), and cardiac tamponade (1.5% vs. 0.8%;p= 0.006). No significant differences were observed in vascular complications, periprocedural stroke, or in-hospital mortality. Average length of stay (LOS) was longer in cancer patients (1.4 ± 2.7 days vs. 1.8 ± 2.5 days;p< 0.001).Conclusions: This nationwide study found that cancer patients undergoing LAAO had an increased rate of in-hospital complications, particularly acute kidney injury, heart failure, and tamponade, but no increase in in-hospital mortality was observed. Further research is needed to evaluate the long-term safety and efficacy of LAAO for managing embolic prevention in this complex patient population.
背景：心房颤动（AF）在癌症患者中较为常见，其发生与共病因素相互影响，并增加血栓栓塞事件风险。恶性肿瘤患者使用抗凝药物常面临多重障碍——与化疗药物的相互作用、肾功能不全、药物不耐受以及出血风险增加。当抗凝治疗不适用时，左心耳封堵术（LAAO）是预防血栓栓塞并发症的有效且安全的非药物干预手段。原始LAAO临床试验通常排除癌症患者，目前该技术对癌症患者的安全性和有效性仍不明确。 方法：本回顾性研究利用美国国家住院患者样本（NIS）数据库，分析了2016年至2019年间美国癌症与非癌症患者接受LAAO治疗的院内结局。通过ICD-10-CM编码提取患者人口统计学特征、合并症、手术操作及院内结局数据。 结果：在全美代表约61,365例LAAO手术的12,273例住院患者中，2.2%（1365例）为癌症患者。癌症组中高龄、男性、慢性肾脏病、卒中史及贫血更为普遍，其中785例（58%）为实体恶性肿瘤，580例（42%）为血液系统恶性肿瘤。与非癌症患者相比，癌症患者院内并发症发生率更高（8.8% vs. 5.7%；p<0.001），主要归因于急性肾损伤（4.4% vs. 2.4%；p=0.002）、急性心力衰竭（3.7% vs. 2.6%；p=0.012）及心脏压塞（1.5% vs. 0.8%；p=0.006）。两组在血管并发症、围手术期卒中及院内死亡率方面无显著差异。癌症患者平均住院时间更长（1.8±2.5天 vs. 1.4±2.7天；p<0.001）。 结论：这项全国性研究表明，接受LAAO治疗的癌症患者院内并发症发生率增加，特别是急性肾损伤、心力衰竭和心脏压塞，但未观察到院内死亡率升高。需要进一步研究评估LAAO在这一复杂患者群体中预防栓塞的长期安全性和有效性。
肿瘤(癌症)患者之家