B-po04-147 trends in early stroke and mortality in epicardial versus endocardial left atrial appendage closure in atrial fibrillation: nationwide readmissions database 2016-2018

Percutaneous left atrial appendage closure (LAAC) devices have emerged as an important alternative to anticoagulation for stroke prevention in patients with atrial fibrillation. National data on recent trends and early complication rates associated with endocardial (endo) LAAC and epicardial (epi) LAAC procedures are limited. To examine the rates and predictors of stroke, mortality, and procedural complications occurring either during index admission or within 90-day readmission after LAAC using a national administrative database. We evaluated 24,198 admissions for LAAC procedures (22,963 endo LAAC and 1,235 epi LAAC) between 2016-2018 using the Nationwide Readmissions Database. Admissions between October and December were excluded to permit 90-day readmission follow-up. Using ICD-10-CM codes, complications occurring during index admission and 90-day readmission were identified. Early stroke and early mortality were defined as events occurring during index admission or readmission. Rates of complications were compared with Fisher's exact test. Multivariable logistic regression was used to identify independent predictors of procedural complications as well as combined early stroke and mortality. Compared to epi LAAC, endo LAAC was associated with lower rates of procedural complications (2.8% vs. 14.5%; p < 0.001), index mortality (0.2% vs. 0.9%; p = 0.003), early mortality (0.5% vs. 1.5%; p = 0.004), and early stroke (0.7% vs. 2.4%; p < 0.001). Between 2016 and 2018, the rates of procedural complications as well as early stroke and mortality did not change significantly. Epi LAAC (aOR 4.5; P<0.0001), coagulopathy (aOR 3.5; P < 0.001), heart failure (aOR 2.2; P < 0.001), and pulmonary hypertension (aOR 2.0; P = 0.002) were independently associated with LAAC procedural complications. Female sex (aOR 1.7; P=0.001), epi LAAC (aOR 2.5; P<0.001), and coagulopathy (aOR 3.3; P=0.001) were independently associated with early stroke and mortality. Endocardial LAAC is associated with lower rates of procedural complications, early stroke, and mortality. In this contemporary real-world analysis over a 3-year period, there was no significant decline in LAAC-associated complications.