In-hospital outcomes of patients with cancer diagnosis undergoing left atrial appendage occlusion: a systematic review and meta-analysis

Abstract Aims Transcatheter left atrial appendage occlusion (LAAO) is an established option for mitigating thromboembolic risk in patients with atrial fibrillation who are intolerant or ineligible for oral anticoagulation. Despite patients with cancer have both increased thrombotic and bleeding risk, the safety and efficacy of LAAO in this patient cohort is largely unknown, considering the exclusion of such patients from randomized studies. Nevertheless, this approach could be particularly beneficial in this patient phenotype. Therefore, the aim of this meta-analysis is to synthesize studies comparing LAAO in patients with and without a cancer diagnosis. Methods We conducted a systematic search across three electronic databases: MEDLINE/PubMed, Cochrane, and Embase, identifying studies comparing outcomes between cancer and non-cancer patients. After selecting all available studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a meta-analysis was performed. Results A total of 6 observational studies were ultimately included in this analysis, encompassing a total of 117,870 patients (11,693 having a cancer diagnosis, 106,177 serving as controls). Outcomes uniformly reported regarded in-hospital mortality and periprocedural complication event rates. In specific, in-hospital mortality was not found to be significantly different between the two cohort Risk Ratio (RR): 0.84; 95% Confidence Interval (95%CI): 0.52-1.38. Similarly, no difference among the evaluated groups was identified in the rate of post-procedural complications (RR: 1.05; 95%CI: 0.70-1.57). However, in the subgroup analysis including studies stratifying patients by cancer status (active or remission), patients with active cancer had significantly higher complications rates (RR: 1.42; 95%CI: 1.23-1.63), in contrast to patients with cancer history (RR: 1.01; 95%CI: 0.70-1.46), which showed a trend towards statistical significance (pinteraction= 0.09). Finally, no significant publication bias was identified using the Egger’s and Begg’s tests (p0.05). Conclusions This meta-analysis demonstrates that transcatheter LAAO has comparable in-hospital mortality and periprocedural complication rates in patients with and without a cancer diagnosis. However, patients with active cancer may be at a significantly increased risk for adverse events. Thus, further randomized studies are needed in order to identify the benefit of LAAO in patients with cancer, compared to medical treatment, as well as evaluate the longer-term safety and efficacy of the procedure.