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)
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 y...
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| Veröffentlicht in: | The American journal of cardiology 2020-12, Vol.136, p.81-86 |
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| creator | Nasasra, Aref El Brachmann, Johannes Lewalter, Thorsten Akin, Ibrahim Sievert, Horst Nienaber, Christoph A. Weiß, Christian Pleger, Sven T. Ince, Hüseyin Maier, Jens Achenbach, Stephan Sigusch, Holger H. Hochadel, Matthias Schneider, Steffen Senges, Jochen Zeymer, Uwe |
| description | 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 |
| doi_str_mv | 10.1016/j.amjcard.2020.09.017 |
| format | Article |
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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.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2020.09.017</identifier><identifier>PMID: 32946860</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Age Factors ; Aged ; Aged, 80 and over ; Atrial Appendage - surgery ; Atrial Fibrillation - surgery ; Female ; Follow-Up Studies ; Germany ; Humans ; Male ; Middle Aged ; Prospective Studies ; Registries ; Septal Occluder Device ; Time Factors ; Treatment Outcome</subject><ispartof>The American journal of cardiology, 2020-12, Vol.136, p.81-86</ispartof><rights>2020</rights><rights>Copyright © 2020. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c365t-205fe5f962a81830e6716be868989bba7ca29280d05e0fe644a4da90013a43c53</citedby><cites>FETCH-LOGICAL-c365t-205fe5f962a81830e6716be868989bba7ca29280d05e0fe644a4da90013a43c53</cites><orcidid>0000-0003-0499-704X ; 0000-0002-9221-9856 ; 0000-0003-3256-0726</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.amjcard.2020.09.017$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3549,27923,27924,45994,64386</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32946860$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nasasra, Aref El</creatorcontrib><creatorcontrib>Brachmann, Johannes</creatorcontrib><creatorcontrib>Lewalter, Thorsten</creatorcontrib><creatorcontrib>Akin, Ibrahim</creatorcontrib><creatorcontrib>Sievert, Horst</creatorcontrib><creatorcontrib>Nienaber, Christoph A.</creatorcontrib><creatorcontrib>Weiß, Christian</creatorcontrib><creatorcontrib>Pleger, Sven T.</creatorcontrib><creatorcontrib>Ince, Hüseyin</creatorcontrib><creatorcontrib>Maier, Jens</creatorcontrib><creatorcontrib>Achenbach, Stephan</creatorcontrib><creatorcontrib>Sigusch, Holger H.</creatorcontrib><creatorcontrib>Hochadel, Matthias</creatorcontrib><creatorcontrib>Schneider, Steffen</creatorcontrib><creatorcontrib>Senges, Jochen</creatorcontrib><creatorcontrib>Zeymer, Uwe</creatorcontrib><title>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)</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>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.</description><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Atrial Appendage - surgery</subject><subject>Atrial Fibrillation - surgery</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Germany</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prospective Studies</subject><subject>Registries</subject><subject>Septal Occluder Device</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc1uEzEUhS0EoqHwCKC7LIsZ7Pm3hKhGURKQglJVBcTK8njuNI7mD9sTKTveoQ_Wd-BJcEmK2LGyrvzdc3TuIeQ1oyGjLHu3C2W3U9LUYUQjGlIeUpY_ITNW5DxgnMVPyYxSGgWcJfyMvLB250fG0uw5OYsjnmRFRmfkfj50ozTaDj3oHq6k09g7C-8hT-E7SmNhaKC8RQjgKxo7Wfj18w5utoNF-PAP1MOmx-Dgh2Cx_yPxTbstlM5o2cJSV0a3rVf3oOxrWGPjHj_LccS-lt5jo1Q71WjgYmmGDtwW4coMdkTl9B7h89Q6rby4J1ZoOtnDuiyvVwu4xlttnTm8fUmeNbK1-Or0npMvy8XN_GOw3qw-zct1oOIsdUFE0wbThmeRLFgRU8xyllVYZAUveFXJXMmIRwWtaYq0wSxJZFJL7g8YyyRWaXxOLo66oxl-TGid6LRV6CP2OExWREmSxAVlaeLR9IgqH8UabMRodCfNQTAqHroUO3HqUjx0KSgXvku_9-ZkMVUd1n-3HsvzwOURQB90r9EIq3x7Cmtt_MVEPej_WPwGWm2y9w</recordid><startdate>20201201</startdate><enddate>20201201</enddate><creator>Nasasra, Aref El</creator><creator>Brachmann, Johannes</creator><creator>Lewalter, Thorsten</creator><creator>Akin, Ibrahim</creator><creator>Sievert, Horst</creator><creator>Nienaber, Christoph A.</creator><creator>Weiß, Christian</creator><creator>Pleger, Sven T.</creator><creator>Ince, Hüseyin</creator><creator>Maier, Jens</creator><creator>Achenbach, Stephan</creator><creator>Sigusch, Holger H.</creator><creator>Hochadel, Matthias</creator><creator>Schneider, Steffen</creator><creator>Senges, Jochen</creator><creator>Zeymer, Uwe</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0499-704X</orcidid><orcidid>https://orcid.org/0000-0002-9221-9856</orcidid><orcidid>https://orcid.org/0000-0003-3256-0726</orcidid></search><sort><creationdate>20201201</creationdate><title>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)</title><author>Nasasra, Aref El ; 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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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32946860</pmid><doi>10.1016/j.amjcard.2020.09.017</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-0499-704X</orcidid><orcidid>https://orcid.org/0000-0002-9221-9856</orcidid><orcidid>https://orcid.org/0000-0003-3256-0726</orcidid></addata></record> |
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| subjects | Age Factors Aged Aged, 80 and over Atrial Appendage - surgery Atrial Fibrillation - surgery Female Follow-Up Studies Germany Humans Male Middle Aged Prospective Studies Registries Septal Occluder Device Time Factors Treatment Outcome |
| title | 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) |
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