Key result
LAAO in cancer patients is linked to similar mortality but ~607% higher major bleeding risk.
Why the study?
Patients with cancer and AF could benefit from percutaneous LAAO, but in-hospital outcomes and readmission data were rarely studied.
Does percutaneous left atrial appendage occlusion (LAAO) have comparable in-hospital outcomes and readmission rates in atrial fibrillation patients with cancer compared to those without cancer?
Cohort (n=60,380)
Yes
Does percutaneous left atrial appendage occlusion (LAAO) have comparable in-hospital outcomes and readmission rates in atrial fibrillation patients with cancer compared to those without cancer?
Absolute Event Rate: 0.27% vs 0.15%
p-value: p=0.54
LAAO is a feasible alternative to anticoagulation for AF in cancer patients, with comparable short-term mortality and readmission rates to non-cancer patients, though it carries a higher risk of pericardial effusion requiring drainage and major bleeding.
May warrant bleeding caution with LAAO in cancer patients; leaves open randomized confirmation of net benefit.
BACKGROUND: Percutaneous left atrial appendage occlusion (LAAO) has been rapidly evolving since FDA's approval in 2015 and has become more of a same-day-discharge procedure. Cancer patient with atrial fibrillation/flutter (AF) population can benefit from the procedure but the in-hospital outcomes and readmission data were rarely studied. OBJECTIVES: We investigated the utilization, in-hospital and readmission outcomes in cancer patients with AF who underwent LAAO. METHODS: Data were derived from the National Inpatient Sample and National Readmissions Database from 2016 to 2019. Patients with primary diagnosis of AF admitted for LAAO (ICD-10 code 02L73DK) were grouped by cancer as a secondary diagnosis. We assessed in-hospital mortality, length of stay, total hospital charges, and complications. Thirty-day readmission rates were compared. RESULTS: LAAO was performed in 60,380 patients with AF and 3% were cancer patients. There were no differences in in-hospital mortality and total hospital charges; however, cancer patients tended to have longer hospital stay (1.59 ± 0.11 vs. 1.32 ± 0.02, p = 0.013). Among complications, cancer patients had higher rates in open or percutaneous pericardial drainage (adjusted odds ratio [aOR] 2.38; 95% confidence interval [CI] 1.19-4.76) and major bleeding events (aOR 7.07; 95% CI 1.82-27.38). There was no statistical significance of 30-day readmission rates between patients with and without cancer (10.0% vs. 9.1%, p = 0.34). The most common readmission reason in cancer patients was gastrointestinal bleeding. CONCLUSIONS: LAAO is a promising procedure in cancer patients complicated by AF with contraindication to anticoagulation. Readmission rate is comparable between patients with and without cancer.
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Zhang et al. (2023) conducted a cohort in Atrial fibrillation/flutter undergoing percutaneous left atrial appendage occlusion (n=60,380). Cancer vs. Non-cancer was evaluated on In-hospital mortality (p=0.54). Cancer patients undergoing percutaneous left atrial appendage occlusion had similar in-hospital mortality compared to non-cancer patients, but experienced longer hospital stays and higher rates of major bleeding (aOR 7.07).
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