Sex Differences in Outcomes Following Left Atrial Appendage Closure

Sanjoy, Shubrandu; Choi, Yunhee; Sparrow, Robert T; Baron, Suzanne J.; Abbott, J. Dawn; Azzalini, Lorenzo; Holmes, David R.; Alraies, M. Chadi; Tzemos, Nikolaos; Ayán, Diana; Mamas, Mamas A.; Bagur, Rodrigo

doi:10.1016/j.mayocp.2020.11.031

Cited by 13 publications

(8 citation statements)

References 34 publications

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“…Nonetheless, population analyses have showed that women compared with men had higher rates of in-hospital adverse outcomes, including bleeding, vascular, cardiac complications, postprocedure stroke, and acute kidney injury after left atrial appendage closure. 70…”

Section: Hf With Preserved Ejection Fractionmentioning

confidence: 99%

Heart Failure Subtypes and Cardiomyopathies in Women

DeFilippis

Beale

Martin

et al. 2022

Circulation Research

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Heart failure affects over 2.6 million women and 3.4 million men in the United States with known sex differences in epidemiology, management, response to treatment, and outcomes across a wide spectrum of cardiomyopathies that include peripartum cardiomyopathy, hypertrophic cardiomyopathy, stress cardiomyopathy, cardiac amyloidosis, and sarcoidosis. Some of these sex-specific considerations are driven by the cellular effects of sex hormones on the renin-angiotensin-aldosterone system, endothelial response to injury, vascular aging, and left ventricular remodeling. Other sex differences are perpetuated by implicit bias leading to undertreatment and underrepresentation in clinical trials. The goal of this narrative review is to comprehensively examine the existing literature over the last decade regarding sex differences in various heart failure syndromes from pathophysiological insights to clinical practice.

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Section: Hf With Preserved Ejection Fractionmentioning

confidence: 99%

Heart Failure Subtypes and Cardiomyopathies in Women

DeFilippis

Beale

Martin

et al. 2022

Circulation Research

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“…Sanjoy et al 14 described the primary composite outcome of bleeding, vascular, cardiac complications, stroke, and acute kidney injury to be higher in women, mainly driven by the occurrence of cardiac complications. Zhao et al 15 and De Caterina et al 16 found no difference in periprocedural complications between the sexes.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, Kleinecke et al 13 completed 1‐year follow‐up of their population and found comparable 1‐year all‐cause stroke and mortality between the sexes. Sanjoy et al 14 described the primary composite outcome of bleeding, vascular, cardiac complications, stroke, and acute kidney injury to be higher in women, mainly driven by the occurrence of cardiac complications. Zhao et al 15 and De Caterina et al 16 found no difference in periprocedural complications between the sexes.…”

Section: Discussionmentioning

confidence: 99%

“…As shown in Figure 1, 6 studies with 64,035 patients (26,120 women and 37,915 men) were included. [11][12][13][14][15][16] Table 1 summarizes the characteristics of the included studies. All studies were observational.…”

Section: Eligible Studiesmentioning

confidence: 99%

“…The largest study recruited patients from the National Cardiovascular Data Registry (NCDR) 11 . The other two included patients from the National Readmission Database (NRD) 12 and the National Inpatient Sample (NIS) database 14 . Although these three databases have different purposes, designs, timeframes, and enrollment criteria, it still raises concerns that a proportion of patients may have replicated in this meta‐analysis.…”

Section: Limitationsmentioning

confidence: 99%

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Sex differences on outcomes following left atrial appendage occlusion in atrial fibrillation: A systematic review and meta‐analysis

Zhu

Sasmita

Xue

et al. 2022

Cathet Cardio Intervent

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There is a lack of sufficient data on sex‐related differences in outcomes of nonvalvular atrial fibrillation (AF) patients following left atrial appendage occlusion (LAAO). We conducted a meta‐analysis to investigate the procedural complications and long‐term outcomes after LAAO in women versus men. We screened Medline, EMBASE, Cochrane Center Register of Controlled Trials, and Clinical http://Trials.gov. The inclusion criteria were studies targeting the sex‐related differences in outcomes in nonvalvular AF patients treated by LAAO. Procedural endpoints of interest included success rate, pericardial complications, major bleeding, and vascular complications during hospitalization. Long‐term outcomes included all‐cause mortality and ischemic stroke during follow‐up. Studies that merely considered sex in the subgroup analysis were not included. Six observational studies with a total of 64,035 patients were identified. The procedural success rates did not differ between sexes (odds ratio [OR]: 0.98, 95% confidence interval [CI]: 0.89–1.09, p = 0.77), while women experienced more pericardial complications (OR: 1.78, 95% CI: 1.58–2.01, p < 0.00001), major bleedings (OR: 2.04, 95% CI: 1.75–2.39, p < 0.00001), and vascular complications (OR: 1.75, 95% CI: 1.41–2.17, p < 0.00001) than men. The sensitivity analysis performed by removing the largest study showed good stability. The long‐term mortality and stroke rates did not differ between women and men in either the 1‐year subgroup or the 2‐year subgroup. In conclusion, despite comparable procedural success rates, women have a significantly higher incidence of pericardial complications, major bleeding, and vascular complications following LAAO. The long‐term mortality and stroke rates do not differ between the sexes.

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