Abstract
Introduction: Percutaneous left atrial appendage occlusion (LAAO) has emerged as a proven alternative for thromboembolism prevention in patients with atrial fibrillation (AF) who cannot tolerate long term anticoagulation. The mean age in clinical trials has been less than 75 years. There are limited data on LAAO safety in older patients. Methods: We used the National Inpatient Sample and ICD-10 codes to identify AF patients who underwent LAAO during the years 2016-2018. Patients were grouped by age <75 and ≥ 75 years. We studied baseline characteristics, length of stay, cost, hospital mortality, and other adverse events, including, hematoma, vascular complications, and perforation/tamponade, and stroke/transient ischemic attack in the two groups. Results: Our search criteria identified a total of 6877 patients, of whom 4160 (60.4%) were ≥ 75 years. LAAO increased similarly among patients in both groups (figure1). The average length of stay after LAAO was 1.5 ± 1.9 days for the entire cohort and did not differ for the two groups (p=0.603). Hospitalization costs were $25635.6 ± 12041.5 among patients ≥ 75 years and $26175.6 ± 11768.0 in those < 75 years (P=0.067). There were 10 deaths in patients ≥75 years and 1 death among patients <75 years (p=0.059). Perforation/tamponade was 1.3% among patients ≥75 years vs 0.6% for those <75 years (p=0.008). This difference persisted on multivariate analysis (OR 1.82; 95% CI 1.04-3.17; p=0.036). There was a trend towards higher combined procedure related adverse events (OR 1.46; 95% CI 0.99-2.15; p= 0.059) among patients ≥75 years. There was no difference in the individual components of hematoma, vascular complication, and stroke/TIA between both groups. Conclusions: Percutaneous LAAO was associated with a higher incidence of perforation and tamponade and a concerning trend towards higher in-hospital mortality among older patients. Further clinical investigations are warranted to explore the risk in this vulnerable group.
Published Version
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