Impact of CHA ₂ DS ₂ ‐VASc Score in the Outcomes of Patients Undergoing a Simplified Pathway for Percutaneous Left Atrial Appendage Closure

Background Percutaneous left atrial appendage closure (LAAC) is usually performed after a pre‐procedural evaluation by transesophageal echocardiography (TOE) or cardiac computed tomography angiography (CCTA). Nevertheless, these ad‐hoc examinations imply an additional use of hospital resources and time spending. Aims To investigate long‐term clinical outcomes, effectiveness and safety of performing LAAC procedures without pre‐procedural imaging assessment in patients with high and very high thromboembolic risk based on CHA 2 DS 2 ‐VASc score. Methods From January 2016 to January 2023, 227 consecutive patients undergoing LAAC following an optimized pathway that removed the use of pre‐procedural TOE or CCTA imaging assessment, were enrolled in this single‐center, retrospective study. Patients were divided into two groups based on thromboembolic risk: 94 had CHA 2 DS 2 ‐VASc scores ≥ 5 and 133 had CHA 2 DS 2 ‐VASc scores < 5). The primary endpoint was a composite of all‐cause death, stroke, systemic embolization, or bleeding events at 2 years. Co‐primary endpoints were device success, device‐related thrombosis (DRT) and peri‐device leaks (PDL) ≥ 3 mm at TOE follow‐up. Results At 2 years, no significant differences were observed between groups in the primary composite endpoint (KM est. 24.81% vs. 20.21%, p log‐rank = 0.7; aHR 0.85, CI: 0.48−1.50, p = 0.58). Device success was 98.7% overall, with no significant differences between groups (aOR 0.32% CI: 0.03−3.80; p = 0.37). DRT and PDL ≥ 3 mm rates were low (4.3% vs. 1.5%, p = 0.26% and 3.2% vs. 2.3%, p = 0.75, respectively). In‐hospital complications were low and comparable in both groups. Conclusions In a consecutive series of patients undergoing LAAC, a simplified approach without pre‐operative imaging assessment showed comparable results at 2‐year for the primary composite endpoint of all‐cause death, stroke, systemic embolization, or bleeding events in patients with CHA 2 DS 2 ‐VASc score ≥ 5 and those with CHA 2 DS 2 ‐VASc score < 5.