Elsevier

The American Journal of Cardiology

Volume 136, 1 December 2020, Pages 81-86
The American Journal of Cardiology

Comparison in Patients < 75 Years of Age - Versus – Those > 75 Years on One-year-Events With Atrial Fibrillation and Left Atrial Appendage Occluder (From the Prospective Multicenter German LAARGE Registry)

https://doi.org/10.1016/j.amjcard.2020.09.017Get rights and content

Left atrial appendage closure (LAAC) is an alternative to oral anticoagulation therapy in patients with non-valvular atrial fibrillation for the prevention of embolic stroke and systemic embolism. Although elderly patients (>75 years) have both higher ischemic and bleeding risk as compared with younger patients, they benefit from optimal anticoagulation. The subanalysis aimed to assess the indications, the safety, efficacy, and 1-year outcomes of interventional LAAC in elderly patients (≥ 75 years) compared with younger (< 75 years) patients in clinical practice. We analyzed data from the prospective Left-Atrium-Appendage Occluder Registry Germany. A total of 638 patients were included in the registry, 402 (63%) were aged ≥ 75 years. Compared with younger subjects, patients aged ≥75 were more likely to have higher CHA2DS2-VASC and HAS-BLED scores. Procedural success rate was high und similar in both groups (97.6%). Periprocedural adverse events were not statistically significant in groups (11.9% in <75 years vs 12.9% in ≥75 years; p = 0.80). At 1 year follow-up, all-cause mortality was higher in patients aged ≥75 compared withwith younger group (13.0% vs 7.8 %,p = 0.04), mainly due to non-cardiovascular causes (10.6% vs 6.0%). No significant differences in major bleeding, stroke, systemic embolism were observed. In conclusion, LAAC is feasible and safe in patients with AF at high stroke risk and with contraindications for OAC and should be considered as candidates for LAA closure. Elderly patients often present these characteristics and could benefit from this novel therapy.

Section snippets

Methods

The German left atrial appendage occlusion registry (LAARGE) is a prospective, nonrandomized, multicenter real-world registry that encompasses consecutive patients with the indication to receive a LAAC from 38 voluntary participating centers. Recruitment into the registry started in July 2014 and ended in December 2015. Patients should have been treated according to current recommendations. 12 Patients ≥18 years planned for LAAC with all 3 types of non-valvular AF, a CHA2DS2-VASc score ≥2 and

Results

A total 638 patients were included in the registry. Of them 402 (63%) were aged ≥ 75 years at the time of the procedure. Baseline characteristics of the study population stratified according to age group are presented in Table 1. Compared with patients < 75 years, patients aged ≥75 had a lower proportion of structural heart disease, a higher prevalence of coronary artery disease, higher prevalence of permanent atrial fibrillation, and higher CHA2DS2-VASC and HAS-BLED scores. There were no

Discussion

The main findings of the present analysis are (1) the identical LAAC procedural success rates in patients aged ≥75 and <75 years, (2) similar rates of stroke and significant bleeding in both groups after 1 year, (3) a higher all-cause mortality triggered by a higher non-cardiovascular mortality rate in the elderly.

In PCI an age older than or equal to 75 years of age constitutes an independent high-risk variable (Bauer et al)18 and the higher prevalence of cardiac and noncardiac diseases

Conclusion

Therapies must be tailored to elderly patients, with particular attention to co-morbidities and bleeding risk. Elderly patients are at increased risk for thromboembolic events und thromboembolic protection is therefore of major importance in this population. LAAC should be kept as alternative in suitable patients and this study adds to the evidence that LAAC is effective in reducing the risk of stroke and major bleeding in AF with a low rate of complications also in the elderly population.

Authors contribution

Author agreement/statement: Aref El Nasasra,MD: writing original draft, completion final draft and editing. Johannes Brachmann, MD: writing review and editing. Thorsten Lewalter, MD: writing review; Ibrahim Akin, MD: writing review and editing; Horst Sievert, MD: writing review. Christoph A. Nienaber, MD: writing review. Christian Weiß, MD: writing review. Sven T. Pleger, MD: writing review. Hüseyin Ince, MD: writing review. Jens Maier, MD: writing review. Stephan Achenbach, MD: writing review.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relations that could have appeared to influence the work reported in this study.

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    The present Left-Atrium-Appendage Occluder Register - GErmany (LAARGE) was conducted independently from industry and only scientifically and financially sponsored by the Stiftung Institut für Herzinfarktforschung (IHF) Ludwigshafen, Germany.For the biometrical analyses of the present work, the IHF was financially supported by an unrestricted grant from Boston Scientific.

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