Arrhythmias & electrophysiology
Association of Surgical Left Atrial Appendage Occlusion With Subsequent Stroke and Mortality Among Patients Undergoing Cardiac Surgery
Authors' conclusion
Among patients undergoing cardiac surgery, concurrent surgical LAAO, compared with no surgical LAAO, was associated with reduced risk of subsequent stroke and all-cause mortality.
Study context
- Population
- Adults (≥18 years) undergoing coronary artery bypass graft (CABG) or valve surgery, US administrative database, 2009–20178,590 propensity score-matched
- Participants
- 75,782 adults
- Exposure
- Surgical LAAO vs no surgical LAAO during cardiac surgery
- LAAOn = 4,374
- Outcome
- Stroke (ischemic stroke or systemic embolism) and all-cause mortality
Methodological detailspropensity-score matched, US administrative database
- Propensity-score matched
- US administrative database
Main finding
As reported in the abstract
mean follow-up 2.1 (SD, 1.9) years
LAAO
- Stroke
- 1.14 events per 100 person-years
- Mortality
- 3.01 events per 100 person-years
No LAAO
- Stroke
- 1.59 events per 100 person-years
- Mortality
- 4.30 events per 100 person-years
Stroke
LAAO1.14 events per 100 person-years
No LAAO1.59 events per 100 person-years
Mortality
LAAO3.01 events per 100 person-years
No LAAO4.30 events per 100 person-years
LAAO vs No LAAOHazard ratio (95% CI)P value
Stroke
0.73(0.56–0.96)
P = 0.03Mortality
0.71(0.60–0.84)
P < 0.001Observational data: associations, not effects.
Secondary outcomes
Events per person-year
| Outcome | LAAO | No LAAO | Absolute difference (events per person-year) (95% CI) | |
|---|---|---|---|---|
| AF-related outpatient visits | 11.96 | 10.26 | 1.70 (1.60–1.80) | |
| −1012Difference, events per person-year (linear scale) |
| Outcome | LAAO | No LAAO | Estimate | P value | |
|---|---|---|---|---|---|
| AF-related outpatient visits | rate ratio 1.17 (95% CI 1.10–1.24) | P < 0.001 | |||
| AF-related hospitalizations | rate ratio 1.13 (95% CI 1.05–1.21) | P = 0.002 | |||
| Stroke and mortality, prior AF (subgroup, 6438/8590 [74.9%])Stroke: 1.11vs 1.71 events per 100 person-years | HR 0.68 (95% CI 0.50–0.92) | P = 0.01 | |||
| Stroke and mortality, prior AF (subgroup, 6438/8590 [74.9%])Mortality: 3.22vs 4.93 events per 100 person-years | HR 0.67 (95% CI 0.56–0.80) | P < 0.001 | |||
| Stroke and mortality, no prior AF (subgroup, 2152/8590 [25.1%])Stroke: 1.23vs 1.26 events per 100 person-years | HR 0.95 (95% CI 0.54–1.68) | ||||
| Stroke and mortality, no prior AF (subgroup, 2152/8590 [25.1%])Mortality: 2.30vs 2.49 events per 100 person-years | HR 0.92 (95% CI 0.61–1.37) | ||||
| Postoperative AF within 30 days (no prior AF) · 30 days after surgery | 27.7% | 20.2% | HR 1.46 (95% CI 1.22–1.73) | P < 0.001 | |
| 0.512Ratio (log scale) |
Event per person-year
| Outcome | LAAO | No LAAO | Absolute difference (event per person-year) (95% CI) | |
|---|---|---|---|---|
| AF-related hospitalizations | 0.36 | 0.32 | 0.04 (0.02–0.06) | |
| −0.0500.050.1Difference, event per person-year (linear scale) |
- Stroke and mortality, prior atrial fibrillation (AF) (subgroup, 6438/8590 [74.9%]): P = .29 for stroke (interaction)
- Stroke and mortality, prior AF (subgroup, 6438/8590 [74.9%]): P = .16 for mortality (interaction)
Original publication
Association of Surgical Left Atrial Appendage Occlusion With Subsequent Stroke and Mortality Among Patients Undergoing Cardiac Surgery. JAMA. Published 22 May 2018. doi:10.
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