Gender‐specific outcomes after percutaneous left atrial appendage closure: A nationwide readmission database analysis

Abstract

Introduction: Thromboembolism-associated stroke is the most feared complication of atrial fibrillation (AF). Percutaneous left atrial appendage closure (pLAAC) is indicated for stroke prevention in patients with AF who can not tolerate long-term anticoagulation. We aim to study gender differences in peri-procedural and readmissions outcomes in pLAAC patients.Methods: Using the national readmission database from January 2016 to December 2018, AF patients undergoing the pLAAC procedure were identified. We used multivariate logistic regression analyses and time-to-event Cox regression analyses to conduct the study. Propensity matching with the Greedy method was done for the accuracy of results.Result: A total of 28 819 patients were included in our study. Among them 11 946 (41.5%) were women and 16 873 (58.6%) were men. The mean age of overall population was 76.1 ± 8.5 years, with women ~1 year older than men. The overall rate of complications was higher in women (8.6% vs. 6.6%, p < .001), primarily driven by bleeding-related complications, that is, major bleed (odds ratio [OR]: 1.32 95%

Sex‐related differences in outcome after left atrial appendage occlusion: Insights from Europe and the EWOLUTION registry

“…11 Additionally, another US nationwide registry with >28.000 included patients with AF and LAAO found an overall higher complication rate in women, primarily driven by bleeding-related complications. 21 In EWOLUTION, we observed a higher LAA sealing rate after the implantation in women, more pericardial effusions in women (pericardial tamponades were rare in both women and men), but a similar periprocedural risk profile with no difference in major bleedings, stroke or in-hospital mortality. The similar, low periprocedural risk profile between women and men may be due to employing the well-studied WATCHMAN Gen 2.5 device and the level of training and experience of the interventionalists in EWOLUTION, as the recent AMULET IDE trial also observed increased pericardial effusion with tamponade if these devices are compared head to head and a decreasing rate with higher operator experience.…”

“…Similarly, the large NCDR LAAO registry found women to have significantly higher risk of in‐hospital adverse events after LAAO compared with men and suggests particular risk reduction strategies to reduce the risk of pericardial effusion and major bleeding in women undergoing LAAO 11 . Additionally, another US nationwide registry with >28.000 included patients with AF and LAAO found an overall higher complication rate in women, primarily driven by bleeding‐related complications 21 . In EWOLUTION, we observed a higher LAA sealing rate after the implantation in women, more pericardial effusions in women (pericardial tamponades were rare in both women and men), but a similar periprocedural risk profile with no difference in major bleedings, stroke or in‐hospital mortality.…”

Not to Rush—Laboratory Parameters and Procedural Complications in Patients Undergoing Left Atrial Appendage Closure

“…Furthermore, literature suggests liver cirrhosis [ 28 ], female sex [ 29 ], and increased age combined with previous gastrointestinal bleeding [ 30 ] are predictive factors for procedural complications. These parameters were not associated with a worse prognosis in this analysis.…”