Five-Year In-Hospital Outcomes After Percutaneous LAA Closure Reported From Nationwide German Study

June 10, 2019—Findings from a large study evaluating 5-year in-hospital trends and safety outcomes of left atrial appendage (LAA) closure in a German nationwide inpatient sample were published by Lukas Hobohm, MD, et al in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions.

The study found that the use of percutaneous LAA closure increased 3.6-fold in Germany from 2011 to 2015, with a nonsignificant uptrend of in-hospital mortality rates in this real-world setting. Important predictors of in-hospital death were acute renal failure, pericardial effusion, and ischemic stroke during hospitalization.

As summarized in JACC: Cardiovascular Interventions, the investigators analyzed data on patient characteristics and in-hospital safety outcomes for all percutaneous LAA closures performed in Germany between 2011 and 2015. The study was composed of 15,895 inpatients.

The annual number of LAA occlusions increased from 1,347 in 2011 to 4,932 in 2015 (β = 1; 95% confidence interval [CI], 0.95–1.01; P < .001), with a nonsignificant uptrend of in-hospital mortality from 0.5% in 2011 to 0.9% in 2015 (β = 0.01; 95% CI, -0.09–0.32; P = .271).

Patient characteristics shifted toward older age and higher prevalence of comorbidities, including heart failure, chronic obstructive pulmonary disease, and chronic renal insufficiency over time. Important independent predictors of in-hospital mortality were:

• Cancer (odds ratio [OR], 2.49; 95% CI, 1–6.12; P = .05)
• Heart failure (OR, 2.42; 95% CI, 1.72–3.41; P < .001)
• Stroke (OR, 5.39; 95% CI, 2.76–10.53; P < .001)
• Acute renal failure (OR, 13.28; 95% CI, 9.08–19.42; P < .001)
• Pericardial effusion (OR, 5.65; 95% CI, 3.76–8.48; P < .001)
• Shock (OR, 45.11; 95% CI, 31.01–65.58; P < .001)