Abstract
PurposeThe recommended stroke prevention for patients with atrial fibrillation (AF) and increased risk of ischemic stroke is oral anticoagulation (OAC). Parts of the patient population are not eligible due to contraindication, and percutaneous left atrial occlusion (LAAO) can then be a preventive treatment option. The aim of this systematic review and meta-analysis is to estimate the long-term clinical effectiveness of LAAO as stroke prevention in patients with AF, increased risk of ischemic stroke, and contraindication to OAC.MethodsWe performed a systematic review and meta-analysis, using Poisson random effect models, to estimate the incidence rate (events per 100 patient-years) of ischemic stroke, transient ischemic attack, major bleeding, and all-cause death after LAAO treatment. We also calculated the risk reduction of ischemic stroke with LAAO compared with no stroke prevention estimated through a predicted risk in an untreated population (5.5 per 100 patient-years).ResultsWe included 29 observational studies in our meta-analysis, including 7 951 individuals and 12 211 patient-years. The mean CHA2DS2-VASc score among the patients in the included studies is 4.32. The pooled incidence rate of ischemic stroke is 1.38 per 100 patient-years (95% CI 1.08; 1.77). According to a meta-regression model, the estimated incidence rate of ischemic stroke at CHA2DS2-VASc 4 is 1.39 per 100 patient-years. This implies a risk reduction of 74.7% with LAAO compared to predicated risk with no stroke prevention.ConclusionsOur results suggest that LAAO is effective as stroke prevention for patients with AF, increased risk of stroke, and contraindication to oral anticoagulation.
Highlights
Stroke was globally the second most common cause of death and cause of disability adjusted life years (DALYs) among adults in 2016 [1]
If patients are eligible for non-vitamin K antagonist oral anticoagulant (NOAC), it is preferred over vitamin K antagonist (VKA) [3]
In the majority of the studies, patients were treated with a dual antiplatelet treatment (DAPT) for 1–6 months, followed by life-long single antiplatelet treatment (APT)
Summary
Stroke was globally the second most common cause of death and cause of disability adjusted life years (DALYs) among adults in 2016 [1]. Approximately 85% are ischemic strokes [2]. A major risk factor for ischemic stroke is atrial fibrillation (AF), which is the most common heart arrhythmia with a prevalence of roughly 3% in the general adult population [3]. Stroke prevention with oral anticoagulation (OAC) is an important part of the treatment regime in patients with AF. The European Society of Cardiology (ESC) state in their guidelines for AF [3] that treatment with OAC is recommended at CHA2DS2-VASc scores of ≥2 for men and ≥3 for women. If patients are eligible for non-vitamin K antagonist oral anticoagulant (NOAC), it is preferred over vitamin K antagonist (VKA) [3]
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