Peri-Procedural Outcomes of Left Atrial Appendage Occlusion in Lower Versus Higher CHA2DS2-VASc Score

Abstract

Percutaneous left atrial appendage occlusion (LAAO) is used to prevent stroke in atrial fibrillation. We present a national registry analysis of peri‑procedural outcomes of LAAO among patients with lower versus higher CHA₂DS₂-VASc score. The National Readmissions Database was used to perform a retrospective review of all hospitalizations for percutaneous endocardial LAAO identified between September 2015 and November 2019. ICD codes for congestive heart failure, hypertension, type 2 diabetes, stroke, transient ischemic attack, thromboembolism, and vascular disease were identified. CHA₂DS₂-VASc was calculated. Lower CHA₂DS₂-VASc score was defined as <5 and higher score as ≥5. Propensity matched (PSM) analysis at index hospitalization and 30 days was used to compare a matched sample of patients undergoing LAAO with lower and higher CHA₂DS₂-VASc. Outcomes examined included all-cause mortality, stroke, major bleeding, pericardial effusion, and cardiac tamponade. A sample of patients who underwent LAAO with lower CHA₂DS₂-VASc (n = 40,879) and higher CHA₂DS₂-VASc (n = 14,438) was identified for crude analysis. From this cohort, a sample of patients with lower CHA₂DS₂-VASc (n = 14,219) and higher CHA₂DS₂-VASc (n = 14,388) was selected for PSM analysis. Both crude and PSM analyses at index hospitalization found higher odds of mortality in the higher CHA₂DS₂-VASc group but no significant difference in odds of major bleeding, stroke, pericardial effusion, or cardiac tamponade. Our findings showed associated a higher CHA₂DS₂-VASc score with a higher risk of mortality without an increased risk of common complications peri‑procedurally. In conclusion, findings display the overall safety of LAAO for patients with both lower and higher CHA₂DS₂-VASc score.

Keywords: CHA(2)DS(2)-VASc; atrial fibrillation; left atrial appendage occlusion; mortality; nationwide readmission database; pericardial effusion; stroke.