Key result
LAAC reduces all-cause mortality ~30% vs warfarin.
Why the study?
Previous analyses showing reduced mortality with LAAC compared with warfarin were limited by patient drop-out, prompting an updated vital status analysis of the PROTECT AF and PREVAIL trials.
Does left atrial appendage closure reduce mortality compared with warfarin in patients with atrial fibrillation?
RCT (n=1,114)
randomized
Yes
Does left atrial appendage closure reduce mortality compared with warfarin in patients with atrial fibrillation?
Updated vital status data from the PROTECT AF and PREVAIL trials demonstrate that left atrial appendage closure is associated with a 30% reduction in all-cause mortality compared to warfarin over 5 years.
Answers are grounded in this paper and cite their sources.
Supports LAA closure over warfarin for mortality reduction in AF; confirms benefit in pooled long-term RCT data.
Compared with warfarin, left atrial appendage closure (LAAC) reduced mortality in an analysis of the PROTECTAF and PREVAIL trials. However, these data were limited by patient drop-out.We sought to estimatethe mortality benefit with LAACusing updated vital status information.In PROTECT AF and PREVAIL, 227 of 1114 randomized subjects failed to complete 5-year follow-up. Centers were manually queried for updated vital status on 76 subjects (33%).During median follow-up 5.0 years (interquartile range 3.8, 5.1), 112 of 732 LAAC subjects (15.3%) and 79 of 382 controls (20.7%) died. The hazard ratio for all-cause mortality with LAAC compared with warfarin was 0.70 (95% CI 0.53-0.94, p=0.017).Subgroup analyses suggested that subjects <75 years and those with higher CHA2DS2-VASc score, history of transient ischemic attack or stroke, and permanent AF derived particular benefit, although interaction terms were not significant.The number needed to treat(NNT) with LAAC to prevent one death over 5 years was 16 (95% CI 10-82). Despite competing mortality risks in this elderly cohort, updated vital status data from PROTECT AF and PREVAIL revealed that LAAC was associated with 30% improved survival compared with warfarin, with an NNT of 16.
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William Whang (2018) conducted an RCT in Atrial fibrillation (n=1,114). Left atrial appendage closure (LAAC) vs. warfarin was evaluated on all-cause mortality (HR 0.70, 95% CI 0.53-0.94, p=0.017). Left atrial appendage closure significantly reduced all-cause mortality compared with warfarin (15.3% vs 20.7%; HR 0.70, 95% CI 0.53-0.94, p=0.017), with a number needed to treat of 16 over 5 years.
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