Gender-Specific Outcomes after Percutaneous Left Atrial
Appendage Closure - A Nationwide Readmission Database Analysis
Abstract:
Background:
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’t
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:
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<0.001), primarily driven by
bleeding-related complications i.e., Major bleed (OR: 1.32 95% CI:
1.03-1.69, p=0.029), blood transfusion (OR: 1.45, 95% CI: 1.06-1.97,
p=0.019) and cardiac tamponade (OR: 1.80, 95% CI: 1.13-2.89, p=0.014).
Women had two times higher peri-procedural ischemic stroke. There was no
difference in peri-procedural mortality. Women remained at 20% and 13%
higher risk for readmission at 30 days and 6 months of discharge.
Conclusion:
Women had higher peri-procedural complications and were at higher risk
of readmissions at 30 days and six months. However, there was no
difference in mortality during the index hospitalization. Further
studies are necessary to determine causality.
Key words: Left atrial appendage, readmissions, stroke, bleeding,
hospitalization
Abbreviation:
AF – Atrial Fibrillation
pLAAC – percutaneous Left Atrial Appendage Closure
NRD – National Readmission Database
ESRD – End Stage Renal Disease
95% CI – 95% confidence interval
OR – Odds Ratio
HR – Hazard Ratio