Long-Term Outcome of Patients with Atrial Fibrillation and High Risk of Stroke Treated with Oral Anticoagulation or Left Atrial Appendage Occlusion: A Cardinality Matched Analysis

Thomas Gilhofer; Victoria Bokemeyer; Victor Schweiger; Mario Gehler; Jonathan Michel; Mi Chen; Alessandro Candreva; Linn Ryberg; Christian Templin; Barbara Stähli; Julia Stehli; Alexander Gotschy; Philipp Jakob; Frank Ruschitzka; Stefanie Aeschbacher; Philipp Krisai; Leo H Bonati; Moa Lina Haller; Nicolas Rodondi; Juerg Beer; Peter Ammann; Giorgio Moschovitis; Elia Rigamonti; Stefan Osswald; David Conen; Fabian Nietlispach; Ronald Karl Binder; Tobias Reichlin; Michael Kühne; Albert Markus Kasel

doi:10.1159/000541907

Long-Term Outcome of Patients with Atrial Fibrillation and High Risk of Stroke Treated with Oral Anticoagulation or Left Atrial Appendage Occlusion: A Cardinality Matched Analysis

Cardiology. 2024 Oct 16:1-15. doi: 10.1159/000541907. Online ahead of print.

Authors

Thomas Gilhofer^{1

2}, Victoria Bokemeyer¹, Victor Schweiger^{1

3}, Mario Gehler⁴, Jonathan Michel¹, Mi Chen¹, Alessandro Candreva¹, Linn Ryberg⁵, Christian Templin⁶, Barbara Stähli^{1

7}, Julia Stehli¹, Alexander Gotschy^{1

8

9}, Philipp Jakob¹, Frank Ruschitzka¹, Stefanie Aeschbacher¹⁰, Philipp Krisai¹⁰, Leo H Bonati¹¹, Moa Lina Haller^{12

13}, Nicolas Rodondi^{12

13}, Juerg Beer^{14

15}, Peter Ammann⁴, Giorgio Moschovitis¹⁶, Elia Rigamonti¹⁶, Stefan Osswald¹⁰, David Conen¹⁷, Fabian Nietlispach¹⁸, Ronald Karl Binder¹⁹, Tobias Reichlin²⁰, Michael Kühne¹⁰, Albert Markus Kasel¹

Affiliations

¹ Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
² Department of Cardiology, Cantonal Hospital Winterthur, Winterthur, Switzerland.
³ Deutsches Herzzentrum der Charité, Campus Virchow-Klinikum, Berlin, Germany.
⁴ Department of Cardiology, Hospital St. Gallen, St. Gallen, Switzerland.
⁵ Department of Internal Medicine, Hospital Zollikerberg, Zollikerberg, Switzerland.
⁶ Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.
⁷ Faculty of Medicine, University of Zurich, Zurich, Switzerland.
⁸ Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
⁹ Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.
¹⁰ Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.
¹¹ Research Department, Rheinfelden, Switzerland.
¹² Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
¹³ Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
¹⁴ Department of Medicine, Cantonal Hospital Baden, Baden, Switzerland.
¹⁵ Laboratory for Platelet Research, University of Zurich, Zurich, Switzerland.
¹⁶ Division of Cardiology, Ente Ospedaliero Cantonale (EOC), Cardiocentro Ticino Institute, Regional Hospital of Lugano, Lugano, Switzerland.
¹⁷ Population Health Research Institute, Hamilton, Ontario, Canada.
¹⁸ Hirslanden Herzzentrum im Park AG Zurich, Zurich, Switzerland.
¹⁹ Department of Internal Medicine, Hospital Wels-Grieskirchen, Wels, Austria.
²⁰ Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

PMID: 39413742
DOI: 10.1159/000541907

Abstract

Introduction: Atrial fibrillation (AF) poses a significant risk of stroke. Left atrial appendage occlusion (LAAO) is an alternative for patients with contraindications to oral anticoagulation (OAC) or with high risk of bleeding. This study aims to compare the outcomes of LAAO versus conventional stroke prevention in high-risk AF-patients.

Methods: This secondary analysis incorporates data from the prospective Swiss-AF and Beat-AF cohorts, and the Zurich LAAO Registry. Cardinality matching was performed to create two comparable cohorts: conventional treatment (92% OAC) and LAAO. The primary endpoint was a composite of stroke, cardiovascular (CV) death, and clinically relevant bleeding. Kaplan-Meier method with competing risk analysis was used.

Results: Each group included 468 patients (age 76.4 [70.5, 82.0] years, 33% female). The LAAO group exhibited higher baseline bleeding risk (HAS BLED 2.0 [1.0-3.0] versus 3.0 [3.0-4.0]; p < 0.001). Median follow-up time: 6.0 (4.7-7.0) years in conventional treatment group and 4.0 (1.5-6.1) in LAAO group. No significant difference in the primary composite endpoint (HR 0.87, 95% CI: 0.72-1.06, p = 0.18), stroke risk (HR 1.14, 95% CI: 0.66-1.97, p = 0.64), or CV mortality (HR 1.08, 95% CI: 0.82-1.42, p = 0.60) was observed between groups. LAAO correlated with a significantly lower risk of clinically relevant bleeding (HR 0.61, 95% CI: 0.47-0.80, p < 0.001).

Conclusion: In this cardinality matched analysis with long-term follow-up, LAAO showed similar stroke and CV death rates but lower clinically relevant bleeding risk compared to conventional therapy in high-risk AF-patients.

Keywords: Atrial fibrillation; High bleeding risk; High stroke risk; Left atrial appendage occlusion; Stroke prevention.