Temporal trends and outcomes of left atrial appendage closure. A national population-based study.

INTRODUCTION AND

OBJECTIVES

Left atrial appendage closure (LAAC) has emerged as a viable stroke prevention strategy in selected patients with nonvalvular atrial fibrillation. The objective of the study was to analyze temporal trends and outcomes of LAAC in a nationwide study.

METHODS

This population-based study analyzed the incidence, epidemiological and clinical characteristics, and outcomes of all patients discharged with a diagnosis of percutaneous LAAC from hospitals included in the Spanish National Health System over a 7-year period (from January 2016 to December 2022).

RESULTS

A total of 3786 patients undergoing percutaneous LAAC were identified. The rate of procedures significantly increased over the study period (annual growth of 23%; IRR, 1.23; 95%CI, 1.17-1.28; P <.001), both in men and in women. The in-hospital mortality rate was 1%, and the incidences of in-hospital concomitant adverse events (AE) and 30-day readmission were 14.0% and 3.5%, respectively. The most frequent AE was the need for blood transfusion (11.5%), followed by vascular complications (2.2%) and acute renal failure (1.9%). The HAS-BLED score was a predictor of in-hospital mortality (OR, 2.55; 95%CI, 1.73-3.74, P <.001) and AE (OR, 1.82, 95%CI, 1.58-2.10; P <.001). Periprocedural AE was less frequent in elective procedures (24.5% vs 11.2%; P <.001) and in high-volume (> 120 procedures) centers (OR, 0.76; 95%CI, 0.63-0.93; P=.008).

CONCLUSIONS

The rate of percutaneous LAAC procedures significantly increased over recent years, with a low in-hospital mortality rate. High volume centers and elective LAAC procedures were significantly associated with a lower risk of AE.