Key result
Left atrial appendage closure in patients ≥80 years resulted in a similar rate of the primary composite endpoint compared to patients <80 years (9.4 vs 7.0/100 patient-years; p=0.19).
Why the study?
LAAC is recommended to reduce stroke risk in patients with atrial fibrillation and contraindications to anticoagulation, but age-stratified data are scarce, especially regarding safety and efficacy in the oldest patients.
Does left atrial appendage closure have similar safety and efficacy in patients ≥80 years compared to those <80 years with atrial fibrillation and contraindications to anticoagulation?
Observational
Yes
Does left atrial appendage closure have similar safety and efficacy in patients ≥80 years compared to those <80 years with atrial fibrillation and contraindications to anticoagulation?
LAAC in octogenarians provides similar protection against thromboembolic events compared to younger patients, though overall mortality is higher due to non-cardiovascular causes.
Answers are grounded in this paper and cite their sources.
LAAC may support similar event rates in octogenarians; leaves open need for randomized confirmation in elderly AF patients.
OBJECTIVE: Left atrial appendage closure (LAAC) is recommended to decrease the stroke risk in patients with atrial fibrillation and contraindications to anticoagulation. However, age-stratified data are scarce. The aim of this study was to provide information on the safety and efficacy of LAAC, with emphasis on the oldest patients. METHODS: A nationwide, prospective, multicentre, observational registry was established by 53 French cardiology centres in 2018-2021. The composite primary endpoint included ischaemic stroke, systemic embolism, and unexplained or cardiovascular death. Separate analyses were done in the groups <80 years and ≥80 years. By contrast, all-cause mortality was significantly higher in octogenarians (15.3 vs 10.1/100 patient-years, p<0.015), due to a higher rate of non-cardiovascular deaths (8.2 vs 4.9/100 patient-years, p=0.034). The rate of the primary endpoint was 8.1/100 patient-years overall with no statistically significant difference between age groups (9.4 and 7.0/100 patient-years; p=0.19). TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT03434015).
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Teíger et al. (2023) conducted an observational in Atrial fibrillation with contraindications to anticoagulation. Left atrial appendage closure (LAAC) in patients ≥80 years vs. Patients <80 years was evaluated on Composite of ischaemic stroke, systemic embolism, and unexplained or cardiovascular death (p=0.19). Left atrial appendage closure in patients ≥80 years resulted in a similar rate of the primary composite endpoint compared to patients <80 years (9.4 vs 7.0/100 patient-years; p=0.19).
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