Key result
Left atrial appendage occlusion significantly reduced the risk of all-cause mortality (RR 0.27) compared to NOAC therapy in patients with atrial fibrillation, with no statistical difference in thromboembolic events.
Why the study?
The effects of left atrial appendage occlusion compared to non-vitamin K antagonist oral anticoagulant therapy in patients with atrial fibrillation remained unknown.
Does left atrial appendage occlusion reduce all-cause mortality and thromboembolic events compared to non-vitamin K antagonist oral anticoagulant therapy in patients with atrial fibrillation?
Cohort (n=108,697)
Yes
Does left atrial appendage occlusion reduce all-cause mortality and thromboembolic events compared to non-vitamin K antagonist oral anticoagulant therapy in patients with atrial fibrillation?
Relative Risk: 0.27 (95% CI 0.14–0.54)
Absolute Event Rate: 1.51% vs 5.6%
Absolute Risk Reduction: 4.09%
p-value: p=<0.001
In a large real-world propensity-matched cohort, LAA occlusion was associated with significantly lower all-cause mortality compared to NOAC therapy at 2 years, with comparable rates of thromboembolic and bleeding events.
Should not yet change practice favoring LAA occlusion over NOACs; leaves open whether the mortality signal is causal.
BACKGROUND: The effects of left atrial appendage (LAA) occlusion compared to non-vitamin K antagonist oral anticoagulant (NOAC) therapy in patients with atrial fibrillation (AF) remain unknown. AIMS: We aimed to evaluate the outcomes in patients with AF who received LAA occlusion vs. NOAC therapy. METHODS: We utilised data from TriNetX which is a global federated health research network currently containing data for 88.5 million patients. ICD-10 codes were employed to identify AF patients treated with either LAA occlusion or NOAC between 1st December 2010 and 17th January 2019. Clinical outcomes of interest were analysed up to 2 years. RESULTS: 108,697 patients were included. Patients who underwent LAA occlusion were younger, more likely to be white Caucasian and male, had a greater incidence of comorbidities, and were less likely to be prescribed other cardiovascular medications. Using propensity score matching, the risk of all-cause mortality was significantly lower among patients who received LAA occlusion compared to NOAC therapy [1.51% vs. 5.60%, RR 0.27 (95% CI 0.14-0.54)], but there were no statistical differences in the composite thrombotic or thromboembolic events [8.17% vs. 7.72%, RR 1.06 (95% CI 0.73-1.53)], ischaemic stroke or TIA [4.69% vs. 5.45%, RR 0.86 (95% CI 0.54-1.38)], venous thromboembolism [1.66% vs. 1.51%, RR 1.10 (95% CI 0.47-2.57)] and intracranial haemorrhage [1.51% vs. 1.51%, RR 1.00 (95% CI 0.42-2.39)]. CONCLUSION: Overall, LAA occlusion might be a suitable alternative to NOAC therapy for stroke prevention in patients with AF.
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Ding et al. (2022) conducted a cohort in Atrial fibrillation (n=108,697). Left atrial appendage occlusion vs. Non-vitamin K antagonist oral anticoagulants (NOAC) was evaluated on All-cause mortality (RR 0.27, 95% CI 0.14-0.54, p=<0.001). Left atrial appendage occlusion significantly reduced the risk of all-cause mortality (RR 0.27) compared to NOAC therapy in patients with atrial fibrillation, with no statistical difference in thromboembolic events.
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