Background and Purpose:As a result of contraindications (eg, frailty, cognitive impairment, comorbidities) or patient refusal, many patients with stroke and atrial fibrillation cannot be discharged on oral anticoagulant. Among them, the proportion of potential candidates for left atrial appendage closure (LAAC) and their 12-month outcome is not well known.Methods:The prospective WATCH-AF registry (Warfarin Aspirin Ten-A Inhibitors and Cerebral Infarction and Hemorrhage and Atrial Fibrillation) enrolled consecutive patients admitted within 72 hours of an acute stroke associated with atrial fibrillation in 2 stroke centers. Scales to evaluate stroke severity, disability, functional independence, risk of fall, cognition, ischemic and hemorrhagic risk-stratification, and comorbidities were systematically collected at admission, discharge, 3, 12 months poststroke. The 2 main end points were death or dependency (modified Rankin Scale score >3) and recurrent stroke (brain infarction and brain hemorrhage).Results:Among 400 enrolled patients (370 with brain infarction, 30 with brain hemorrhage), 31 died before discharge and 57 (14.3%) were possible European Heart Rhythm Association/European Society of Cardiology and American Heart Association/American College of Cardiology/Heart Rhythm Society candidates for LAAC. At 12 months, the rate of death or dependency was 17.9%, and the rate of stroke recurrence was 9.8% in the 274/400 (68.5%) patients discharged on a long-term oral anticoagulant strategy, as compared with 17.5% and 24.7%, respectively, in 57 patients candidate for LAAC. As compared with patients on a long-term oral anticoagulant strategy, there was a 2-fold increase in the risk of stroke recurrence in the group with an indication for LAAC (adjusted hazard ratio, 2.58 [95% CI, 1.40–4.76]; P=0.002).Conclusions:Fourteen percent of patients with stroke associated with atrial fibrillation were potential candidates for LAAC. The 12-month stroke risk of these candidates was 3-fold the risk of anticoagulated patients.

中文翻译：

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房颤卒中后左心耳封堵的潜在患病率和结果：WATCH-AF注册中心。

背景与目的：由于禁忌症（例如，身体虚弱，认知障碍，合并症）或患者拒绝治疗，许多中风和房颤患者不能口服抗凝剂。其中，尚不清楚左心耳封堵术（LAAC）潜在候选者的比例及其12个月的结局。 ）纳入了在2个卒中中心发生急性卒中并与房颤相关的连续患者，共72小时。在入院，出院时，系统地收集了评估卒中严重性，残疾，功能独立性，跌倒风险，认知，局部缺血性和出血性风险分层以及合并症的量表，3，中风后12个月。2个主要终点是死亡或依赖性（改良兰金量表评分> 3）和复发性中风（脑梗死和脑出血）。结果：在400例患者中（370例脑梗死，30例脑出血），有31例在出院前死亡欧洲心律协会/欧洲心脏病学会和美国心脏协会/美国心脏病学会/心律学会有57位（14.3％）可能成为LAAC候选人。在12个月时，采用长期口服抗凝治疗策略出院的274/400（68.5％）患者的死亡率或依赖性率为17.9％，中风复发率为9.8％，相比之下，分别为17.5％和24.7分别在57位LAAC患者中占％。与采用长期口服抗凝策略的患者相比，有LAAC适应症的组中风复发风险增加了2倍（风险比调整后为2.58 [95％CI，1.40–4.76]； P = 0.002）。结论：14％的中风患者与心房颤动相关的是潜在的LAAC候选者。这些候选人的12个月中风风险是抗凝患者风险的3倍。