Key result
Left atrial appendage closure was associated with a lower risk of ischemic/hemorrhagic stroke, TIA, and mortality compared to no LAAC (2.5% vs 5.4%; HR 0.38; 95% CI 0.17-0.88; P=0.024).
Why the study?
Patients with HCM and AF have an increased stroke risk compared to those with non-valvular AF without HCM, prompting investigation into the role of left atrial appendage closure.
Does left atrial appendage closure reduce the composite of stroke, TIA, and mortality in patients with hypertrophic cardiomyopathy and atrial fibrillation?
Cohort (n=71,980)
Yes
Does left atrial appendage closure reduce the composite of stroke, TIA, and mortality in patients with hypertrophic cardiomyopathy and atrial fibrillation?
Effect estimate: HR 0.38 (95% CI 0.17-0.88)
Absolute Event Rate: 2.5% vs 5.4%
p-value: p=0.024
In patients with hypertrophic cardiomyopathy and atrial fibrillation, left atrial appendage closure is associated with a significantly lower risk of stroke, TIA, and mortality, as well as reduced major bleeding.
BACKGROUND: Patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF) are at increased stroke risk in comparison to those with non-valvular AF not affected by HCM. OBJECTIVES: To investigate the role of left atrial appendage closure (LAAC) in patients with HCM and AF. METHODS AND RESULTS: We identified patients with HCM and AF using the National Readmission Dataset. Patients were stratified based on LAAC status. The primary efficacy outcome was a composite of ischaemic and haemorrhagic stroke, TIA, and all-cause mortality. The primary safety outcome was a composite of major bleeding and pericardial complications. Patients were matched using inverse probability of treatment weighting. Cox-proportional hazard regression was applied to calculate the hazard ratio (HR) with a 95% confidence interval (CI) on matched cohorts. We identified 71 980 patients with HCM and AF. 1351 (1.9%) patients underwent LAAC. Two hundred and eighty-seven (21.2%) underwent transcatheter LAAC. LAAC was associated with a lower risk of the primary efficacy outcome (2.5% vs. 5.4%, HR: 0.38; 95% CI: 0.17-0.88; P = 0.024), the primary safety outcome (2.9% vs. 6.8%, HR: 0.39; 95% CI: 0.23-0.66, P = 0.001), and reduced major bleeding. The LAAC group trended towards a lower risk of ischaemic stroke and all-cause mortality. CONCLUSION: Surgical and transcatheter LAAC was associated with a lower risk of haemorrhagic stroke and major bleeding.
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Khawaja et al. (2023) conducted a cohort in Hypertrophic cardiomyopathy and atrial fibrillation (n=71,980). Left atrial appendage closure (surgical and transcatheter) vs. No left atrial appendage closure was evaluated on Composite of ischaemic and haemorrhagic stroke, TIA, and all-cause mortality (HR 0.38, 95% CI 0.17-0.88, p=0.024). Left atrial appendage closure was associated with a lower risk of ischemic/hemorrhagic stroke, TIA, and mortality compared to no LAAC (2.5% vs 5.4%; HR 0.38; 95% CI 0.17-0.88; P=0.024).
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