Left Atrial Appendage Occlusion in the Elderly: Insights From PROTECT-AF, PREVAIL, and Continuous Access Registries.
atrial fibrillation
left atrial appendage occlusion
octogenarian
stroke
Journal
JACC. Clinical electrophysiology
ISSN: 2405-5018
Titre abrégé: JACC Clin Electrophysiol
Pays: United States
ID NLM: 101656995
Informations de publication
Date de publication:
05 2023
05 2023
Historique:
received:
17
01
2023
revised:
17
02
2023
accepted:
17
02
2023
medline:
26
5
2023
pubmed:
9
3
2023
entrez:
8
3
2023
Statut:
ppublish
Résumé
Data on the safety and efficacy of left atrial appendage occlusion (LAAO) in elderly patients are limited. This study aimed to compare the outcomes of LAAO between patients ≥80 and <80 years of age. We included patients enrolled in randomized trials and nonrandomized registries of the Watchman 2.5 device. The primary efficacy endpoint was a composite of cardiovascular/unknown death, stroke, or systemic embolism at 5 years. Secondary endpoints included cardiovascular/unknown death, stroke, systemic embolism, and major and nonprocedural bleeding. Survival analyses were performed using the Kaplan-Meier, Cox proportional hazards, and competing risk analysis methods. Interaction terms were used to compare the 2 age groups. We also estimated the average treatment effect of the device with the use of inverse probability weighting. We studied 2,258 patients, of whom 570 (25.2%) were ≥80 years old, and 1,688 (74.8%) were <80 years old. Procedural complications at 7 days were similar in both age groups. The primary endpoint occurred in 12.0% in the device group vs 13.8% in the control group (HR: 0.9; 95% CI: 0.6-1.4) among patients <80 years of age and in 25.3% vs 21.7%, respectively (HR: 1.2; 95% CI: 0.7-2.0) among patients ≥80 (interaction P = 0.48). There was no interaction between age and treatment effect for any of the secondary outcomes. The average treatment effects of LAAO (compared with warfarin) were similar in the elderly population (compared with younger patients). Despite the higher event rates, octogenarians derive similar benefits from LAAO as their younger counterparts. Age alone should not preclude LAAO in otherwise suitable candidates.
Sections du résumé
BACKGROUND
Data on the safety and efficacy of left atrial appendage occlusion (LAAO) in elderly patients are limited.
OBJECTIVES
This study aimed to compare the outcomes of LAAO between patients ≥80 and <80 years of age.
METHODS
We included patients enrolled in randomized trials and nonrandomized registries of the Watchman 2.5 device. The primary efficacy endpoint was a composite of cardiovascular/unknown death, stroke, or systemic embolism at 5 years. Secondary endpoints included cardiovascular/unknown death, stroke, systemic embolism, and major and nonprocedural bleeding. Survival analyses were performed using the Kaplan-Meier, Cox proportional hazards, and competing risk analysis methods. Interaction terms were used to compare the 2 age groups. We also estimated the average treatment effect of the device with the use of inverse probability weighting.
RESULTS
We studied 2,258 patients, of whom 570 (25.2%) were ≥80 years old, and 1,688 (74.8%) were <80 years old. Procedural complications at 7 days were similar in both age groups. The primary endpoint occurred in 12.0% in the device group vs 13.8% in the control group (HR: 0.9; 95% CI: 0.6-1.4) among patients <80 years of age and in 25.3% vs 21.7%, respectively (HR: 1.2; 95% CI: 0.7-2.0) among patients ≥80 (interaction P = 0.48). There was no interaction between age and treatment effect for any of the secondary outcomes. The average treatment effects of LAAO (compared with warfarin) were similar in the elderly population (compared with younger patients).
CONCLUSIONS
Despite the higher event rates, octogenarians derive similar benefits from LAAO as their younger counterparts. Age alone should not preclude LAAO in otherwise suitable candidates.
Identifiants
pubmed: 36890047
pii: S2405-500X(23)00102-0
doi: 10.1016/j.jacep.2023.02.007
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
669-676Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Funding Support and Author Disclosures This study was funded by Boston Scientific. Drs Roy and Alloco are employees and stockholders of Boston Scientific. Dr de Backer has received institutional research grants from Abbott and Boston Scientific. Dr Alkhouli received consultation fees and research grants (institutional) from Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.