Oral anticoagulation remains the standard treatment for stroke prevention in patients with atrial fibrillation. However, many patients have a high bleeding risk or contraindications to long-term anticoagulant therapy. In this context, percutaneous left atrial appendage closure (LAAC) has become an established therapeutic alternative for selected patients. The present study analyzed temporal trends and outcomes of LAAC in Spain using the National Health System database between 2016 and 2022.
The primary endpoint was in-hospital mortality and the incidence of in-hospital adverse events. Secondary endpoints included 30-day cardiovascular readmissions and predictors associated with complications.
A total of 3,786 patients underwent LAAC, with a mean age of 74 years; 63% were male. The procedure showed sustained growth, increasing from 0.6 to 2.3 interventions per 100,000 inhabitants between 2016 and 2022, representing an annual increase of 23% (IRR=1.23; 95% CI: 1.17–1.28; p<0.001). Additionally, 77.6% of procedures were performed electively.
In-hospital mortality was 1%. The overall adverse event rate reached 14%, with blood transfusion being the most frequent complication (11.5%), followed by vascular complications (2.2%), acute kidney injury (1.9%), and stroke (0.6%). Thirty-day cardiovascular readmissions occurred in 3.5% of patients.
Non-elective procedures were associated with a significantly higher incidence of adverse events compared with elective procedures (24.5% vs. 11.2%; p<0.001). Likewise, a higher HAS-BLED score was independently associated with increased in-hospital mortality (OR=2.55; 95% CI: 1.73–3.74; p<0.001) and a greater risk of complications (OR=1.82; 95% CI: 1.58–2.10; p<0.001).
Read also: HERA-TAVI: Intra-Annular vs Supra-Annular Valves in TAVI.
Another relevant finding was that high-volume centers, defined as those performing more than 120 procedures, experienced fewer adverse events than lower-volume centers.
Interestingly, the cohort exhibited relatively low HAS-BLED scores, suggesting that in routine clinical practice in Spain, left atrial appendage closure has expanded to patients with moderate bleeding risk and not exclusively to those with absolute contraindications to anticoagulation.
Conclusion: Left Atrial Appendage Closure Demonstrated a Favorable Safety Profile in Spain
In conclusion, percutaneous left atrial appendage closure experienced sustained growth in Spain over recent years, accompanied by low in-hospital mortality and a favorable safety profile. The best outcomes were observed in elective procedures and in high-volume centers, reinforcing the importance of appropriate patient selection and institutional experience to optimize clinical results.
Original Title: Temporal Trends and Outcomes of Left Atrial Appendage Closure. A National Population-Based Study.
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