Department of Internal Medicine Cleveland Clinic Cleveland OH.
Heart and Vascular Institute Cleveland Clinic Cleveland OH.
J Am Heart Assoc. 2022 Aug 16;11(16):e024574. doi: 10.1161/JAHA.121.024574. Epub 2022 Aug 5.
Background Data on percutaneous left atrial appendage closure (LAAC) outcomes in the very elderly with atrial fibrillation are limited. We aimed to investigate the clinical characteristics and short-term outcomes of patients 80 years or older following percutaneous LAAC in a large nationwide database. Methods and Results Using the Nationwide Readmissions Database, we identified patients who underwent percutaneous LAAC between January 2016 and December 2018. Patients were categorized based on age (≥80 and <80 years old). The primary outcome was in-hospital mortality. Secondary outcomes were in-hospital end points including periprocedural complications, 30-day outcomes, and all-cause 30-day readmissions. A propensity score-matched model (1:1) was used to adjust for baseline characteristics among the study groups. A total of 13 208 patients were included in this study (43% women, median age in years [interquartile range] 79.5 [73-84]) and matched one-to-one (6604 and 6604 patients were ≥80 and <80 years old, respectively). In-hospital mortality was not statistically different between the study groups and occurred in 21 patients ≥80 years old (0.32%) and in 14 patients <80 years old (0.21%); =0.236. Rates of in-hospital stroke/transient ischemic attack were higher in patients ≥80 years old compared with those <80 years old (1.22% versus 0.77%; =0.009). In-hospital bleeding requiring transfusion, vascular complications, systemic embolization, and pericardial effusion/tamponade requiring pericardiocentesis or surgical intervention occurred more frequently in patients ≥80 years old. Furthermore, the elderly group was more likely to be readmitted within 30 days compared with those <80 years old (9.91% versus 8.4%; =0.004); however, rates of 30-day complications were not statistically different between the study groups. Conclusions In a large nationwide database, patients ≥80 years old undergoing percutaneous LAAC were found to have similar in-hospital mortality but an increased risk of periprocedural complications and 30-day readmission compared with younger patients. Our data suggest that LAAC should be considered on a case-by-case basis in the very elderly, taking into consideration the risks and benefits of this intervention. Further studies are needed to assess long-term LAAC outcomes in this high-risk population.
背景 关于高龄（≥80 岁）心房颤动患者经皮左心耳封堵术（LAAC）结局的数据有限。本研究旨在通过全国范围内的大型数据库，调查 LAAC 术后高龄患者的临床特征和短期结局。
方法 利用全国再入院数据库，我们纳入了 2016 年 1 月至 2018 年 12 月期间行 LAAC 的患者。根据年龄（≥80 岁和＜80 岁）将患者进行分组。主要结局为院内死亡率。次要结局为围术期并发症、30 天结局和全因 30 天再入院。采用倾向评分匹配模型（1:1）调整研究组间的基线特征。共纳入 13208 例患者（43%为女性，中位年龄为 79.5[73-84]岁），并进行了一对一匹配（≥80 岁和＜80 岁患者各 6604 例）。研究组间院内死亡率无统计学差异，≥80 岁组有 21 例（0.32%）和＜80 岁组有 14 例（0.21%）患者死亡（=0.236）。与＜80 岁组相比，≥80 岁组院内卒中/短暂性脑缺血发作发生率更高（1.22%比 0.77%；=0.009）。与＜80 岁组相比，≥80 岁组更易发生需要输血的院内出血、血管并发症、全身栓塞和需要心包穿刺或外科干预的心包积液/填塞。此外，与＜80 岁组相比，≥80 岁组 30 天内再入院率更高（9.91%比 8.4%；=0.004），但两组间 30 天内并发症发生率无统计学差异。
结论 在全国范围内的大型数据库中，与年轻患者相比，接受 LAAC 的高龄（≥80 岁）患者院内死亡率相似，但围术期并发症和 30 天内再入院风险更高。我们的数据表明，对于极高危患者，LAAC 应根据具体情况考虑，权衡利弊。需要进一步研究评估该高危人群的 LAAC 长期结局。
