OBJECTIVES Whether left atrial appendage closure(LAAC)in octogenarians yield similar net clinical benefit compared to younger patients,was the purpose of the present study.METHODS Two real-world LAAC registries,enroll...OBJECTIVES Whether left atrial appendage closure(LAAC)in octogenarians yield similar net clinical benefit compared to younger patients,was the purpose of the present study.METHODS Two real-world LAAC registries,enrolling 744 consecutive Amplatzer and Watchman patients from 2009 to 2018,were retrospectively analyzed.RESULTS All events are reported per 100 patient-years.Two hundred and sixty one octogenarians and 483 non-octogenarians with a mean follow-up of 1.7±1.3 and 2.3±1.6 years,and a total of 1,502 patient-years were included.Octogenarians had a higher risk for stroke(CHA2DS2-VASc score:5.2±1.2 vs.4.3±1.7,P<0.0001)and bleeding(HAS-BLED score:3.3±0.8 vs.3.1±1.1,P=0.001).The combined safety endpoint of major periprocedural complications and major bleeding events at follow-up was comparable(30/446,6.7%vs.47/1056,4.4%;hazard ratio[HR]=1.2;95%confidence interval[CI]:0.73−1.98;P=0.48)between the groups.The efficacy endpoint of all-cause stroke,systemic embolism,and cardiovascular/unexplained death occurred more often in octogenarians(61/446,13.7%vs.80/1056,7.6%;HR=7.0;95%CI:4.53−10.93;P<0.0001).Overall,octogenarians had a lower net clinical benefit,i.e.,the composite of all above mentioned hazards,from LAAC compared to younger patients(82/446,18.4%vs.116/1056,11.0%;HR=4.6;95%CI:3.11−7.0;P<0.0001).Compared to the anticipated stroke rate,the observed rate de-creased by 41%in octogenarians and 53%in non-octogenarians.The observed bleeding rate was reduced by 10%octogenarians and 41%non-octogenarians.CONCLUSIONS LAAC can be performed with similar safety in octogenarians as compared to younger patients.On the long-term,it both reduces stroke and bleeding events,although to a lesser extent than in non-octogenarians.展开更多
文摘OBJECTIVES Whether left atrial appendage closure(LAAC)in octogenarians yield similar net clinical benefit compared to younger patients,was the purpose of the present study.METHODS Two real-world LAAC registries,enrolling 744 consecutive Amplatzer and Watchman patients from 2009 to 2018,were retrospectively analyzed.RESULTS All events are reported per 100 patient-years.Two hundred and sixty one octogenarians and 483 non-octogenarians with a mean follow-up of 1.7±1.3 and 2.3±1.6 years,and a total of 1,502 patient-years were included.Octogenarians had a higher risk for stroke(CHA2DS2-VASc score:5.2±1.2 vs.4.3±1.7,P<0.0001)and bleeding(HAS-BLED score:3.3±0.8 vs.3.1±1.1,P=0.001).The combined safety endpoint of major periprocedural complications and major bleeding events at follow-up was comparable(30/446,6.7%vs.47/1056,4.4%;hazard ratio[HR]=1.2;95%confidence interval[CI]:0.73−1.98;P=0.48)between the groups.The efficacy endpoint of all-cause stroke,systemic embolism,and cardiovascular/unexplained death occurred more often in octogenarians(61/446,13.7%vs.80/1056,7.6%;HR=7.0;95%CI:4.53−10.93;P<0.0001).Overall,octogenarians had a lower net clinical benefit,i.e.,the composite of all above mentioned hazards,from LAAC compared to younger patients(82/446,18.4%vs.116/1056,11.0%;HR=4.6;95%CI:3.11−7.0;P<0.0001).Compared to the anticipated stroke rate,the observed rate de-creased by 41%in octogenarians and 53%in non-octogenarians.The observed bleeding rate was reduced by 10%octogenarians and 41%non-octogenarians.CONCLUSIONS LAAC can be performed with similar safety in octogenarians as compared to younger patients.On the long-term,it both reduces stroke and bleeding events,although to a lesser extent than in non-octogenarians.
基金The BigData@Heart project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 116074This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation programme and European Federation of Pharmaceutical Industries and Associations.
