Voran Jakob Christoph, Seoudy Hatim, Leye Marius, Kolbrink Benedikt, Schulte Kevin, Dempfle Astrid, Frank Derk, Kreidel Felix
Department of Internal Medicine III, Cardiology and Critical Care, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany.
Clin Res Cardiol. 2025 Jan 7. doi: 10.1007/s00392-024-02586-0.
LAAO is an interventional, prophylactic treatment to prevent cardioembolic stroke in patients with non-valvular atrial fibrillation.
The aim of this study was to assess gender differences and age-related in-hospital course of all patients undergoing left atrial appendage occlusion (LAAO) in Germany.
The Research Data Center of the Federal Statistical Office accessed interrogation of its Diagnosis Related Groups (DRG) statistics database. In a retrospective observational manner, all German in-hospital cases from 2016 to 2022 with a coded LAAO procedure were analyzed.
LAAO was performed on a total of 40,435 patients, 39.2% of whom were female. The relative frequency of procedures in the German male population over the age of 60 was twice as high as in the German female population. The median age was 78 (IQR: 72-82) years. Compared to 28.3% in 2016, in 2022 40.1% of all patients were over 80 years of age (increased by 152%). Cases of patients over 85 years of age increased from 7.7 to 11.4% during the same time period. We found an in-hospital death rate for patients < 70, 70-75, 80-85 and > 85 years of age of 0.8, 1.0, 1.4 and 2.2% respectively. Further, we saw significantly higher MACE rates (< 75 years: 4%, 75-85 years: 5%, > 85 years: 7%) in patients with a higher age. Gender was not significantly associated with a higher rate of in-hospital mortality.
In Germany, LAAO is increasingly performed in older patients with a strong gender imbalance. Age was independently associated with higher in-hospital MACE and mortality rates. This data provides a further basis to balance risks and benefits of LAAO as a preventive procedure and highlights the need for further prospective studies.
左心耳封堵术（LAAO）是一种预防性介入治疗方法，用于预防非瓣膜性心房颤动患者发生心源性栓塞性卒中。
本研究旨在评估德国所有接受左心耳封堵术（LAAO）患者的性别差异及与年龄相关的住院病程。
联邦统计局研究数据中心对其诊断相关分组（DRG）统计数据库进行查询。采用回顾性观察方法，分析了2016年至2022年德国所有编码为LAAO手术的住院病例。
共对40435例患者实施了LAAO，其中39.2%为女性。60岁以上德国男性人群中该手术的相对频率是德国女性人群的两倍。中位年龄为78岁（四分位间距：72 - 82岁）。与2016年的28.3%相比，2022年所有患者中有40.1%年龄超过80岁（增加了152%）。同期85岁以上患者的比例从7.7%增至11.4%。我们发现年龄＜70岁、70 - 75岁、80 - 85岁和＞85岁患者的住院死亡率分别为0.8%、1.0%、1.4%和2.2%。此外，年龄较大的患者中主要不良心血管事件（MACE）发生率显著更高（＜75岁：4%，75 - 85岁：5%，＞85岁：7%）。性别与较高的住院死亡率无显著相关性。
在德国，LAAO越来越多地应用于年龄较大的患者，且存在明显的性别失衡。年龄与较高的住院MACE及死亡率独立相关。这些数据为平衡LAAO作为一种预防措施的风险和益处提供了进一步依据，并突出了进一步开展前瞻性研究的必要性。
