March 7, 2023EP EuropaceOpen Access

Outcomes of percutaneous left atrial appendage occlusion device implantation in atrial fibrillation patients based on underlying stroke risk

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Why the study?

It was unknown how underlying stroke risk defined by CHA2DS2-VASc score affects outcomes in atrial fibrillation patients undergoing percutaneous left atrial appendage occlusion.

Does a higher CHA2DS2-VASc score predict increased peri-procedural complications and resource utilization in atrial fibrillation patients undergoing percutaneous left atrial appendage occlusion?

Structured PICO

Does a higher CHA2DS2-VASc score predict increased peri-procedural complications and resource utilization in atrial fibrillation patients undergoing percutaneous left atrial appendage occlusion?

Population

73,795 atrial fibrillation patients undergoing percutaneous left atrial appendage occlusion (LAAO), stratified by CHA2DS2-VASc score (3, 4, and ≥5), identified from the National Inpatient Sample (2016-2020).

Intervention

LAAO in patients with higher CHA2DS2-VASc scores (4 and ≥5)

Comparator

LAAO in patients with a CHA2DS2-VASc score of 3

Outcome

Complications and resource utilizationsafety

In patients undergoing percutaneous left atrial appendage occlusion, a higher baseline CHA2DS2-VASc score is independently associated with an increased risk of peri-procedural complications and prolonged hospital length of stay.

Implication

Higher CHA2DS2-VASc may signal elevated peri-procedural risk with LAAO; leaves open whether score-based selection improves outcomes.

Abstract

AIMS: To determine outcomes in atrial fibrillation patients undergoing percutaneous left atrial appendage occlusion (LAAO) based on the underlying stroke risk (defined by the CHA2DS2-VASc score). METHODS AND RESULTS: Data were extracted from the National Inpatient Sample for calendar years 2016-20. Left atrial appendage occlusion implantations were identified on the basis of the International Classification of Diseases, 10th Revision, Clinical Modification code of 02L73DK. The study sample was stratified on the basis of the CHA2DS2-VASc score into three groups (scores of 3, 4, and ≥5). The outcomes assessed in our study included complications and resource utilization. A total of 73 795 LAAO device implantations were studied. Approximately 63% of LAAO device implantations occurred in patients with CHA2DS2-VASc scores of 4 and ≥5. The crude prevalence of pericardial effusion requiring intervention was higher with increased CHA2DS2-VASc score (1.4% in patients with a score of ≥5 vs. 1.1% in patients with a score of 4 vs. 0.8% in patients with a score of 3, P < 0.01). In the multivariable model adjusted for potential confounders, CHA2DS2-VASc scores of 4 and ≥5 were found to be independently associated with overall complications [adjusted odds ratio (aOR) 1.26, 95% confidence interval (CI) 1.18-1.35, and aOR 1.88, 95% CI 1.73-2.04, respectively] and prolonged length of stay (aOR 1.18, 95% CI 1.11-1.25, and aOR 1.54, 95% CI 1.44-1.66, respectively). CONCLUSION: A higher CHA2DS2-VASc score was associated with an increased risk of peri-procedural complications and resource utilization after LAAO. These findings highlight the importance of patient selection for the LAAO procedure and need validation in future studies.