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Paitazoglou C, Eitel I, Stiermaier T, Ince H, Kische S, Pokushalov E, Schmitz T, Schmidt B, Gori T, Meincke F, Vireca E, Wohlmuth P, Lucas B, Bergmann MW. Sex-related differences in outcome after left atrial appendage occlusion: Insights from Europe and the EWOLUTION registry. Catheter Cardiovasc Interv 2023. [PMID: 37393575 DOI: 10.1002/ccd.30759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/18/2023] [Accepted: 06/18/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Women with atrial fibrillation (AF) generally experience worse symptoms, poorer quality of life, and have a higher risk of stroke and death. There is limited availability of sex-related differences regarding left atrial appendage occlusion (LAAO). AIMS The aim of this study was to evaluate the sex-related differences in patients undergoing LAAO in EWOLUTION. METHODS A total of 1025 patients scheduled for elective LAAO therapy employing the WATCHMAN Gen 2.5 prospectively consented for participation; 1005 patients received a successful implant and were followed for 2 years. As we detected sex-related differences in baseline data we performed a propensity score matching. The primary endpoint is a combined endpoint of survival free from mortality, major bleeding, ischemic stroke, transitory ischemic attack (TIA) and systemic embolization (SE) up to 2-year clinical follow-up. Secondary Endpoints were periprocedural data and overall 2-year survival. RESULTS Women were older but had less often vascular disease and hemorrhagic stroke. There was no sex-related significant difference after LAAO at 2 years in the combined endpoint of survival free from mortality, major bleeding, ischemic stroke, TIA, and SE (female vs. male: 79% vs.76%, p = 0.24) or in overall survival (female vs. male: 85% vs. 82%, p = 0.16). Procedural data showed a higher sealing rate after the implantation in women (complete sealing female 94% vs. male 90%, p = 0.033), significantly more pericardial effusions (female 1.2% vs. male 0.2%, p = 0.031) and a similar periprocedural risk profile. CONCLUSIONS Females undergoing LAAO differ in various baseline variables, but after adjustment, we observed similar safety and efficacy of LAAO with no significant difference in long-term outcomes between women and men.
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Affiliation(s)
- Christina Paitazoglou
- Department Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), University Schleswig-Holstein (UKSH), University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
| | - Ingo Eitel
- Department Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), University Schleswig-Holstein (UKSH), University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
| | - Thomas Stiermaier
- Department Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), University Schleswig-Holstein (UKSH), University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
| | - Hueseyin Ince
- Department of Cardiology, Vivantes Klinikum Neukölln and Klinikum Am Urban, Berlin, Germany
- Department of Cardiology, University Rostock, Rostock, Germany
| | - Stephan Kische
- Department of Cardiology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Evgeny Pokushalov
- Department of Cardiology, E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Thomas Schmitz
- Department of Cardiology, Elisabeth Krankenhaus, Essen, Germany
| | - Boris Schmidt
- Department of Cardiology, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Tommaso Gori
- Department of Cardiology, Universitätsmedizin Mainz und DZHK Standort Rhein-Main, Mainz, Germany
| | | | | | | | - Boersma Lucas
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
- Amsterdam UMV, Amsterdam, The Netherlands
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Mathai SV, Sohal S, Flatow E, Nagaraj S, Hajra A, Chugh Y, Palaiodimos L, Lee HJ, Ansari J, Cohen M, Volgman AS, Faillace R. Sex Differences in Periprocedural and Long-Term Outcomes Following Transcatheter Left Atrial Appendage Occlusion: A Systematic Review and Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 48:23-31. [PMID: 36336589 DOI: 10.1016/j.carrev.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/01/2022] [Accepted: 10/04/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is among the most common arrhythmias associated with an increased risk of cardioembolic phenomena, including stroke. Percutaneous left atrial appendage occlusion (LAAO) has proven beneficial in reducing stroke and mortality in patients with atrial fibrillation who have contraindications to anticoagulation. However, the sex differences in outcomes following LAAO have not been studied systematically. METHODS Electronic databases PUBMED, Embase, and Web of Science were systematically searched until March 2022 for studies evaluating patient outcomes following LAAO for AF. The primary outcomes of interest were the risks of periprocedural stroke, major bleeding, pericardial complications, and all-cause mortality. Secondary outcomes included stroke risks, major bleeding, device-related thrombus, cardiovascular and all-cause mortality on long-term follow-up. A random-effects model meta-analysis was conducted, and heterogeneity was assessed using the I-squared test. RESULTS Sixteen studies were included in the final analysis encompassing 111,775 patients, out of which 45,441 (40.7 %) were women. Women had a significantly higher risk of peri-procedural complications including all-cause mortality [relative risk (RR), 95 % confidence intervals (CI); RR 1.94, 95 % CI 1.40-2.69], stroke [RR 1.85, 95 % CI 1.29-2.67], major bleeding [RR 1.63, 95 % CI 1.08-2.44], and pericardial events [RR 1.80, 95 % CI 1.58-2.05]. However, there were no statistically significant differences between sexes in terms of risk of stroke, major bleeding, device-related thrombus, cardiovascular and all-cause mortality on long-term follow-up. CONCLUSION Among patients undergoing LAAO implantation, women were at higher risk of periprocedural complications than men. This risk was not significant on long-term follow-up.
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Affiliation(s)
- Sheetal Vasundara Mathai
- Department of Medicine, NYC Health +Hospitals/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY 10461, United States of America.
| | - Sumit Sohal
- Division of Cardiology, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, United States of America
| | - Elie Flatow
- Department of Medicine, NYC Health +Hospitals/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY 10461, United States of America
| | - Sanjana Nagaraj
- Department of Medicine, NYC Health +Hospitals/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY 10461, United States of America
| | - Adrija Hajra
- Department of Medicine, NYC Health +Hospitals/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY 10461, United States of America
| | - Yashasvi Chugh
- Division of Interventional and Structural Cardiology, Department of Medicine, Minneapolis Heart Institute, Minneapolis, MN, United States of America
| | - Leonidas Palaiodimos
- Department of Medicine, NYC Health +Hospitals/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY 10461, United States of America
| | - Hyon Jae Lee
- Division of Cardiology, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, United States of America
| | - Julia Ansari
- Division of Cardiology, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, United States of America
| | - Marc Cohen
- Division of Cardiology, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, United States of America
| | - Annabelle Santos Volgman
- Division of Cardiology, Department of Medicine, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, United States of America
| | - Robert Faillace
- Department of Medicine, NYC Health +Hospitals/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY 10461, United States of America
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Not to Rush-Laboratory Parameters and Procedural Complications in Patients Undergoing Left Atrial Appendage Closure. J Clin Med 2022; 11:jcm11216548. [PMID: 36362774 PMCID: PMC9656817 DOI: 10.3390/jcm11216548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
Background: As a preventive procedure, minimizing periprocedural risk is crucially important during left atrial appendage closure (LAAC). Methods: We included consecutive patients receiving LAAC at nine centres and assessed the relationship between baseline characteristics and the acute procedural outcome. Major procedural complications were defined as all complications requiring immediate invasive intervention or causing irreversible damage. Logistic regression was performed and included age and left-ventricular function. Furthermore, the association between acute complications and long-term outcomes was evaluated. Results: A total of 405 consecutive patients with a median age of 75 years (37% female) were included. 47% had a history of stroke. Median CHA2DS2-VASc score was 4 (interquartile range, 3−5) and the median HAS-BLED score was 3 (2−4). Major procedural complications occurred in 7% of cases. Low haemoglobin (OR 0.8, 95% CI 0.65−0.99 per g/dL, p = 0.040) and end-stage kidney disease (OR 13.0, CI 2.5−68.5, p = 0.002) remained significant in multivariate analysis. Anaemia (haemoglobin < 12 and < 13 g/dL in female and male patients) increased the risk of complications 2.2-fold. Conclusions: The major complication rate was low in this high-risk patient population undergoing LAAC. End-stage kidney disease and low baseline haemoglobin were independently associated with a higher major complication rate.
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