Risk of cerebrovascular events in patients after left atrial appendage closure: results from large, real-world dataset

Background

Although left atrial appendage closure (LAAc) has evolved as an alternative to long-term anticoagulation for prevention of thromboembolism, but there is still residual risk of cerebrovascular events during the follow-up period after LAAc.

Purpose

In our study, we sought to assess the incidence and risk of residual cerebrovascular events after LAAc from a large, real-world based dataset.

Methods

We identified a total of 12,903 patients who underwent LAAc during the time-period of 01/2025 and 10/2022. For the purpose of our analysis, we had excluded patients with prior history of cerebrovascular events. We then assessed the incidence of cerebrovascular events (stratified by etiology: ischemic vs. hemorrhagic) at 30-day, 1-year and 3-year follow-up time period after the LAAc procedure. To assess the risk-factors of cerebrovascular events, we then conducted logistic regression using Cox-proportional hazard model for ischemic and hemorrhagic etiologies separately.

Results

Overall, the incidence of ischemic stroke and hemorrhagic stroke were 0.4% and 0.1% during the initial 30-days after the LAAc procedure. At 1 year follow-up the rates of ischemic and hemorrhagic strokes were 2.5% and 0.6%, with the 3-year rates being 6.1% and 1.2% respectively (Figure). On multivariable analysis, type 2 diabetes mellitus (adjusted HR: 1.08, 95% CI of 1.01-1.2, p = 0.04), hypertension (adjusted HR of 1.5, 95% CI of 1.28-1.63, p < 0.0001) and impaired left ventricular ejection fraction (EF of < 20%, adjusted HR of 1.5, 95% CI of 1.14-1.93, p = 0.003) were independently associated with the increased risk of ischemic stroke after LAAc.

In our analyses for hemorrhagic stroke after LAAc, we observed impaired LVEF of < 20% (adjusted HR of 2.02, 95% CI of 1.30- 3.14, p = 0.002) and HTN (adjusted HR of 1.6, 95% CI of 1.28-1.97, p < 0.0001) to be the independent risk factors.

Conclusions

In our study based on a large, real-world dataset, we observed residual risk of both ischemic and hemorrhagic cerebrovascular events both at short-term and long-term follow-up time intervals after LAAc. Pre-procedural risk factors such as a significantly impaired LVEF of < 20% and HTN were important risk factors for both these events. Our findings highlight the need for considering these 2 risk factors to guide management of risk-factors and anticoagulation regimen after LAAc.Stroke rates after LAA Closure