Left Atrial Appendage Closure: As Effective in Men and Women?

Atrial fibrillation is the most prevalent arrhythmia and to prevent its potential complications, we should administer anticoagulants (OACs), either warfarin or the new direct oral anticoagulants (DOACs). 

Cierre de orejuela de aurícula izquierda

Even though these drugs have been shown effective, they still involve the risk of bleeding, especially gastrointestinal bleeding, which in turn leads to numerous hospitalizations.

Left atrial appendage occlusion devices (LAAO) have been shown beneficial, even though in general terms they show similar outcomes to oral anticoagulants (OACs). At present, they are clearly recommended for patients who for whatever reason cannot be treated with OACs. 

There is little evidence looking at these benefits by sex.

This was a meta-analysis of the prospective EVOLUTION study, carried out in Europe in patients receiving the WATCHMAN in a “real world” context. The sample included 408 women and 612 men. 

Primary end point assessed the combination of mortality free survival, severe bleeding, ischemic stroke, TIA and systemic embolism over 2 years. 

Read also: Predictors and Evolution of Permanent Pacemaker After TAVR with Self-Expanding Valves.

Even though women were older (75 ± 9 vs. 73 ± 9 years, p < 0.001), they showed a lower incidence of peripheral vascular disease, hemorrhagic stroke and alcohol abuse. However, CHA2DS2‐VASc‐Score was superior (5 ± 1.5 vs. 4.1 ± 1.5, p < 0.001) and HAS‐BLED Score was comparable, with no difference in the rest of risk factors. 

During procedure, women showed better sealing vs. men (94% vs. 90%, p = 0.033), but presented higher incidence of pericardial effusion (1.2% vs. 0.2%, p = 0.031). Pericardial effusion and cardiac tamponade were rare, and similar between groups. 

After two years, there were no difference between men and women in primary end point (79% vs. 76%, p = 0.24) or survival (85% vs. 82%, p = 0.16).

Conclusion

Even though women undergoing LAAO differ in baseline characteristics, after adjusting for variables they showed similar safety and efficacy, with no significant differences at long term followup between men and women. 

Dr. Carlos Fava - Consejo Editorial SOLACI

Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.

Original Title: Sex‐related differences in outcome after left atrial appendage occlusion: Insights from Europe and the EWOLUTION registry.

Reference: Christina Paitazoglou, et al. 


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

More articles by this author

ACCESS-TAVI: Comparing Post TAVR Vascular Closure Devices

Transcatheter aortic valve replacement (TAVR) is a well-established option to treat elderly patients with severe symptomatic aortic valve stenosis. Technical advances and device development...

Coronary Artery Disease in Aortic Stenosis: CABG + SAVR vs. TAVR + PCI: Data from Spanish Centers

Multiple randomized studies have shown comparable or superior efficacy of transcatheter aortic valve replacement (TAVR) vs. coronary artery bypass graft (CABG).  However, many of...

TCT 2024 | TRISCEND II: A New Hope in Percutaneous Tricuspid Valve Replacement

Advanced tricuspid regurgitation (TR) is a debilitating disease associated with heart failure and increased mortality.  Edge-to-edge repair has been shown to improve both clinical condition...

TCT 2024 – EVOLVED trial: Early Intervention for Patients with Severe Asymptomatic Aortic Stenosis and Myocardial Fibrosis?

Treating symptomatic severe aortic stenosis (AS) with aortic valve replacement is currently considered a class I recommendation, evidence level B, according to the current...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

ACCESS-TAVI: Comparing Post TAVR Vascular Closure Devices

Transcatheter aortic valve replacement (TAVR) is a well-established option to treat elderly patients with severe symptomatic aortic valve stenosis. Technical advances and device development...

Endovascular Treatment of Iliofemoral Disease for the Improvement of Heart Failure with Preserved Ejection Fraction

Peripheral artery disease (PAD) is a significant risk factor in the development of difficult-to-treat conditions, such as heart failure with preserved ejection fraction (HFpEF)....

Coronary Artery Disease in Aortic Stenosis: CABG + SAVR vs. TAVR + PCI: Data from Spanish Centers

Multiple randomized studies have shown comparable or superior efficacy of transcatheter aortic valve replacement (TAVR) vs. coronary artery bypass graft (CABG).  However, many of...