Safety and efficacy of"One-Stop Intervention"in patients with atrial fibrillation comorbid with coronary heart disease
Objective To explore the safety and efficacy of"One-Stop Intervention"treatment[simultaneous left atrial ap-pendage closure combined with percutaneous coronary intervention(PCI)]in patients with atrial fibrillation comorbid with coronary heart disease,and provide evidence for clinical treatment of these patients.Methods A total of 56 patients with at-rial fibrillation and coronary heart disease admitted to the Department of Cardiology of The First Affiliated Hospital of Army Medical University from August 2014 to November 2022 were selected as the study participants.Among them,17 patients who underwent simultaneous left atrial appendage closure and PCI were assigned to the One-Stop Intervention group,and 39 patients who underwent staged surgery were assigned to the non-One Stop Intervention group.General information such as gender,age,and underlying diseases,as well as examination results of transthoracic echocardiography(TTE)and transesophage-al echocardiography(TEE),were collected for both groups.The occurrence of postoperative ischemic stroke,major bleeding,de-vice-related thrombus(DRT),and heart failure readmission was followed up.Results Significant differences were observed in the proportion of patients with New York Heart Association(NYHA)functional class Ⅲ and LDL-C levels between the two groups(x2=4.016,P=0.045;t=2.305,P=0.025).No significant differences were found in age,gender composition,smoking and drinking rates,proportions of hypertension,diabetes,peripheral arterial disease,CHA2DS2-VASc score,HAS-BLED score,and other data between the two groups(P＞0.05).The maximum width of left atrial appendage implantation in the One-Stop Intervention group and the non-One Stop Intervention group was(20.76±3.05)mm and(20.49±2.38)mm,re-spectively,and the maximum depth was(27.18±4.98)mm and(27.26±4.58)mm,respectively,with no significant differences(t=0.367,0.058,P=0.715,0.954).The diameter of the left atrial appendage closure device in the One-Stop Intervention group and the non-One Stop Intervention group was(26.65±2.98)mm and(26.54±3.41)mm,respectively,with no significant difference(t=0.114,P=0.910).The number of stents implanted in the One-Stop Intervention group and the non-One Stop Intervention group was(1.00±0.00)and(1.26±0.55),respectively,with a significant difference(t=2.919,P=0.006).No significant difference was found in the occurrence of residual shunt after left atrial appendage closure between the two groups(x2=1.057,P=0.229).There were no significant differences in the left atrial(LA)an-teroposterior diameter,right atrial(RA)transverse diameter,left ventricular(LV)anteroposterior diameter,right ventric-ular(RV)anteroposterior diameter,and left ventricular ejection fraction(LVEF)before and 3 months after surgery be-tween the two groups(P＞).05).There was no significant difference in the occurrence of follow-up terminal events be-tween the two groups(x2=0.014,P=0.906).The Kaplan-Meier survival curves of terminal events in the two groups showed no significant difference(P=0.912).Conclusion The One-Stop Intervention treatment is safe and effective for patients with atrial fibrillation comorbid with coronary heart disease,holding promise for clinical application.
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