Clinical benefit of left atrial appendage closure in octogenarians

Yamen Mohrez; Steffen Gloekler; Steffen Schnupp; Wasim Allakkis; Xiao-Xia Liu; Monika Fuerholz; Johannes Brachmann; Stephan Windecker; Stephan Achenbach; Bernhard Meier; Caroline Kleinecke

doi:10.11909/j.issn.1671-5411.2021.11.003

Volume 18 Issue 11

Nov. 2021

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Article Navigation > Journal of Geriatric Cardiology > 2021 > 18(11): 886-896

Please cite this article as: Mohrez Y, Gloekler S, Schnupp S, Allakkis W, Liu XX, Fuerholz M, Brachmann J, Windecker S, Achenbach S, Meier B, Kleinecke C. Clinical benefit of left atrial appendage closure in octogenarians. J Geriatr Cardiol 2021; 18(11): 886−896. DOI: 10.11909/j.issn.1671-5411.2021.11.003

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Please cite this article as: Mohrez Y, Gloekler S, Schnupp S, Allakkis W, Liu XX, Fuerholz M, Brachmann J, Windecker S, Achenbach S, Meier B, Kleinecke C. Clinical benefit of left atrial appendage closure in octogenarians. J Geriatr Cardiol 2021; 18(11): 886−896. DOI: 10.11909/j.issn.1671-5411.2021.11.003

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Clinical benefit of left atrial appendage closure in octogenarians

doi: 10.11909/j.issn.1671-5411.2021.11.003

1.
Department of Cardiology, Klinikum Coburg, Coburg, Germany
2.
Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
3.
Department of Cardiology, Klinikum Hochrhein, Waldshut-Tiengen, Germany
4.
Department of Cardiology, Beijing Anzhen Hospital, Beijing, China
5.
Department of Cardiology, Friedrich-Alexander University Erlangen-Nuernberg, Erlangen, Germany

^*The authors contributed equally to this manuscript

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Corresponding author: carolinekleinecke@web.de
Accepted Date: 2021-11-10
Publish Date: 2021-11-30

Abstract

Abstract

OBJECTIVES Whether left atrial appendage closure (LAAC) in octogenarians yield similar net clinical benefit compared to younger patients, was the purpose of the present study. METHODS Two real-world LAAC registries, enrolling 744 consecutive Amplatzer and Watchman patients from 2009 to 2018, were retrospectively analyzed. RESULTS All events are reported per 100 patient-years. Two hundred and sixty one octogenarians and 483 non-octogenarians with a mean follow-up of 1.7 ± 1.3 and 2.3 ± 1.6 years, and a total of 1,502 patient-years were included. Octogenarians had a higher risk for stroke (CHA₂DS₂-VASc score: 5.2 ± 1.2 vs. 4.3 ± 1.7, P < 0.0001) and bleeding (HAS-BLED score: 3.3 ± 0.8 vs. 3.1 ± 1.1, P = 0.001). The combined safety endpoint of major periprocedural complications and major bleeding events at follow-up was comparable (30/446, 6.7% vs. 47/1056, 4.4%; hazard ratio [HR] = 1.2; 95% confidence interval [CI]: 0.73−1.98; P = 0.48) between the groups. The efficacy endpoint of all-cause stroke, systemic embolism, and cardiovascular/unexplained death occurred more often in octogenarians (61/446, 13.7% vs. 80/1056, 7.6%; HR = 7.0; 95% CI: 4.53−10.93; P < 0.0001). Overall, octogenarians had a lower net clinical benefit, i.e., the composite of all above mentioned hazards, from LAAC compared to younger patients (82/446, 18.4% vs. 116/1056, 11.0%; HR = 4.6; 95% CI: 3.11−7.0; P < 0.0001). Compared to the anticipated stroke rate, the observed rate decreased by 41% in octogenarians and 53% in non-octogenarians. The observed bleeding rate was reduced by 10% octogenarians and 41% non-octogenarians. CONCLUSIONS LAAC can be performed with similar safety in octogenarians as compared to younger patients. On the long-term, it both reduces stroke and bleeding events, although to a lesser extent than in non-octogenarians.

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References(26)

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