Cierre de orejuela izquierda frente a ACOD en pacientes mayores: análisis con emparejamiento por puntuación de propensión

  1. Berenice Caneiro Queija 1
  2. Rodrigo Estévez Loureiro 1
  3. Sergio Raposeiras Roubín 1
  4. Emad Abu Assi 1
  5. Rocío González Ferreiro 1
  6. Ignacio Cruz González 2
  7. Alejandro Diego Nieto 2
  8. Antonio de Miguel Castro 1
  9. Guillermo Bastos Fernández 1
  10. José A. Baz Alonso 1
  11. Guilles O’Hara 3
  12. Josep Rodés-Cabau 3
  13. A. Íñiguez Romo 1
  1. 1 Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, España
  2. 2 Servicio de Cardiología, Hospital Universitario de Salamanca, Salamanca, España
  3. 3 Institut Universitaire de Cardiologie et Pneumologie de Quebec, Quebec, Canadá
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Journal:
REC: Interventional Cardiology

ISSN: 2604-7276,  2604-7306

Year of publication: 2022

Volume: 4

Issue: 4

Pages: 304-310

Type: Article

DOI: 10.24875/RECIC.M22000316 DIALNET GOOGLE SCHOLAR lock_openDialnet editor

More publications in: REC: Interventional Cardiology

Abstract

Introduction and objectives: Information comparing left atrial appendage closure (LAAC) to direct oral anticoagulation (DOAC) therapy is scarce. Our aim is to compare the clinical outcomes between LAAC and DOACs on an elderly population (> 80 years of age). Methods: We retrospectively collected 1144 octogenarian patients with atrial fibrillation from 3 different tertiary hospitals. A total of 970 patients received DOACs and 174 patients were treated with LAAC. At baseline, both groups had similar cardiovascular risk factors. The LAAC group had more history of bleeding, anemia or previous cancer. We conducted a propensity score matching study and obtained 2 different paired groups of 58 patients with similar baseline risk factors, comorbidities, and risk scores who received DOACs or were treated with LAAC. The outcomes of the therapeutic strategy used (DOACs or LAAC) were assessed using the Cox regression analysis. Results: During a median follow-up of 2.0 years [range 0.9-3.5] no differences regarding the primary endpoint (a composite of death, major bleeding, and stroke) were found (HR, 1.05; 95%CI, 0.15-7.51). Bleeding events were similar in both groups with no statistically significant differences being reported (HR, 1.79; 95%CI, 0.73-4.41). Mortality rate was numerically higher in patients on DOACs (31.8%) vs LAAC (26.4%). However, this finding did not reach statistical significance (HR, 0.70; 95%CI, 0.33-1.47; P = .343). Conclusions: Compared to DOACs, LAAC has not shown any differences regarding embolic events, bleeding, and mortality in a population of elderly patients > 80 years of age. In our population, LAAC is a strategy as safe and effective as DOACs, and is an alternative to be taken into consideration in real-world patients > 80 years.

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