Key result
Left atrial appendage occlusion showed no significant difference in stroke, CV death, and clinically relevant bleeding compared to conventional therapy.
Why the study?
AF poses a significant risk of stroke and LAAO is an alternative to OAC, but outcomes comparing LAAO versus conventional stroke prevention in high-risk AF patients required evaluation.
Does left atrial appendage occlusion reduce the composite of stroke, cardiovascular death, and clinically relevant bleeding in high-risk patients with atrial fibrillation compared to conventional treatment?
Cohort (n=936)
Yes
Does left atrial appendage occlusion reduce the composite of stroke, cardiovascular death, and clinically relevant bleeding in high-risk patients with atrial fibrillation compared to conventional treatment?
In high-risk patients with atrial fibrillation, left atrial appendage occlusion provides similar long-term protection against stroke and cardiovascular death as conventional oral anticoagulation, while significantly reducing the risk of clinically relevant bleeding.
Answers are grounded in this paper and cite their sources.
LAAO was associated with similar stroke/CV death rates but lower bleeding versus OAC in matched high-risk AF; leaves open confirmation in randomized trials.
INTRODUCTION: Atrial fibrillation (AF) poses a significant risk of stroke. Left atrial appendage occlusion (LAAO) is an alternative for patients with contraindications to oral anticoagulation (OAC) or with high risk of bleeding. This study aims to compare the outcomes of LAAO versus conventional stroke prevention in high-risk AF-patients. METHODS: This secondary analysis incorporates data from the prospective Swiss-AF and Beat-AF cohorts, and the Zurich LAAO Registry. Cardinality matching was performed to create two comparable cohorts: conventional treatment (92% OAC) and LAAO. The primary endpoint was a composite of stroke, cardiovascular (CV) death, and clinically relevant bleeding. Kaplan-Meier method with competing risk analysis was used. RESULTS: Each group included 468 patients (age 76.4 [70.5, 82.0] years, 33% female). The LAAO group exhibited higher baseline bleeding risk (HAS BLED 2.0 [1.0-3.0] versus 3.0 [3.0-4.0]; p < 0.001). Median follow-up time: 6.0 (4.7-7.0) years in conventional treatment group and 4.0 (1.5-6.1) in LAAO group. No significant difference in the primary composite endpoint (HR 0.87, 95% CI: 0.72-1.06, p = 0.18), stroke risk (HR 1.14, 95% CI: 0.66-1.97, p = 0.64), or CV mortality (HR 1.08, 95% CI: 0.82-1.42, p = 0.60) was observed between groups. LAAO correlated with a significantly lower risk of clinically relevant bleeding (HR 0.61, 95% CI: 0.47-0.80, p < 0.001). CONCLUSION: In this cardinality matched analysis with long-term follow-up, LAAO showed similar stroke and CV death rates but lower clinically relevant bleeding risk compared to conventional therapy in high-risk AF-patients.
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Gilhofer et al. (2024) conducted a cohort in Atrial fibrillation (n=936). Left atrial appendage occlusion (LAAO) vs. Conventional treatment (92% OAC) was evaluated on Composite of stroke, cardiovascular (CV) death, and clinically relevant bleeding (HR 0.87, 95% CI 0.72-1.06, p=0.18). Left atrial appendage occlusion showed no significant difference in stroke, CV death, and clinically relevant bleeding compared to conventional therapy.
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