Left Atrial Appendage Closure: Is the Strategy Enough to Lower Long-Term Stroke Risk?

AbstractPurpose of ReviewLeft atrial appendage closure (LAAC) emerged as a promising site-directed therapy to mitigate stroke risk in patients ineligible for long-term oral anticoagulation. We sought to summarize the current evidence regarding the role of LAAC on long-term risk of ischemic stroke and systemic thromboembolism.Recent FindingsData from EWOLUTION registry provides real world evidence on the 1-year outcomes of LAAC by WATCHMAN device. The annual ischemic stroke rate was 1.1 per 100 patient-years, as opposed to the CHADS2VASC score-predicted stroke rate of 7.2% (84% relative risk reduction). No differences in death, stroke, or bleeding rates were observed between patients with or without a contraindication for anticoagulation or based on type of anticoagulant used. Pooled registry data in patients who underwent Amplatzer Cardiac Plug (ACP) demonstrate an observed stroke rate of 2.0 –2.7% as opposed to CHADS2VASC score-predicted stroke rate of 5.6–8.3% over a median follow-up ~ 5 years. Recent studies evaluating efficacy of LARIAT over a median follow of ~3 years demonstrate that the observed ischemic stroke rate was 1% as opposed to the expected stroke rate of 6.2%. A recent propensity score matched observational study by Melduni RM et al. demonstrated that patients with AF who underwent routine LAAC during elective cardiac surgery (CABG/valvular surgery) were found to have higher risk (OR = 2.83) of postoperative AF with no effect on long-term stroke ris...
Source: Current Cardiovascular Risk Reports - Category: Cardiology Source Type: research