Clinical Electrophysiology -> Atrial Fibrillation & Atrial Flutter: -> Left Atrial Appendage Closure D-BT01 - Cardiac Electrophysiology Society (CES): Lunch and Young Investigator Award Poster Session (ID 41) Special Session

D-BT01-20 - Early Stroke And Mortality Following Percutaneous Left Atrial Appendage Closure For Stroke Prevention In Atrial Fibrillation: The United States Nationwide Readmissions Database 2010-15 (ID 858)

Abstract

Background: Although rates of adverse events associated with percutaneous left atrial appendage (LAA) closure have been reported to be low in clinical trials, there is a paucity of real-world, nationally representative data on stroke and mortality early after LAA closure.
Objective: To examine rates and predictors of procedural complications, stroke and mortality occurring during index admission or 90-day readmission after LAA closure using a national administrative database.
Methods: We evaluated 2,575 admissions for LAA closure between 2010 and 2015 using the Nationwide Readmissions Database. Using ICD-9-CM codes, we identified procedural complications occurring during index admission for LAA closure. We defined early stroke and early mortality as events occurring either during index admission or during 90-day readmission, respectively. Multivariable logistic regression was used to identify independent predictors of procedural complications, early stroke and early mortality.
Results: Between 2010 and 2015, the rate of procedural complications, early stroke, early mortality and composite early stroke/mortality after LAA closure were 24.9%, 1.3%, 2.9%, and 4.2% respectively. Procedural complication rates of cardiac perforation, stroke, hemorrhage, and cardiogenic shock were 2.8%, 1.0%, 6.3% and 1.9%, respectively. Open cardiac surgery was required in 6.3% of cases during index hospitalization. After adjustment for age, sex, and comorbidities, coagulopathy (aOR 2.8; P<0.001), valvular disease (aOR 2.6; P<0.001), pulmonary hypertension (aOR 1.8; P=0.014), and small hospital bed size (aOR 1.9; P=0.020) were independently associated with procedural complications. Coagulopathy (aOR 4.6; P<0.001), low household income (aOR 3.2; P=0.002), and female sex (aOR 2.5; P=0.005) were independently associated with early stroke/mortality.
Conclusion: The frequency of procedural complications, early stroke and mortality following LAA closure in an analysis of a real-world population during early adoption of this procedure are higher than those reported in clinical trials.
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