Author + information
- Received February 14, 2019
- Revision received March 29, 2019
- Accepted April 3, 2019
- Published online June 3, 2019.
- Lukas Hobohm, MDa,b,∗ (, )
- Ralph S. von Bardeleben, MDa,
- Mir A. Ostad, MDa,
- Philip Wenzel, MDa,b,c,
- Thomas Münzel, MDa,c,
- Tommaso Gori, MDa,c,∗ and
- Karsten Keller, MDa,b,∗
- aCenter of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
- bCenter for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
- cGerman Center for Cardiovascular Research, Partner Site Rhine Main, Mainz, Germany
- ↵∗Address for correspondence:
Dr. Lukas Hobohm, Center of Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
Objectives The aim of this study was to evaluate 5-year in-hospital trends and safety outcomes of left atrial appendage (LAA) closure in the German nationwide inpatient sample.
Background The safety and efficacy of percutaneous LAA closure have been demonstrated in randomized trials and prospective cohort studies, but results from large samples are missing.
Methods Data on patient characteristics and in-hospital safety outcomes for all percutaneous LAA closures performed in Germany between 2011 and 2015 were analyzed. Overall, 15,895 inpatients were included.
Results The annual number of LAA occlusions increased from 1,347 in 2011 to 4,932 in 2015 (β = 1.00; 95% confidence interval [CI]: 0.95 to 1.01; p < 0.001), with a nonsignificant uptrend of in-hospital mortality (from 0.5% in 2011 to 0.9% in 2015; β = 0.01; 95% CI: −0.09 to 0.32; p = 0.271). Patient characteristics shifted toward older age and higher prevalence of comorbidities such as heart failure, chronic obstructive pulmonary disease, and chronic renal insufficiency over time. Important independent predictors of in-hospital mortality were cancer (odds ratio [OR]: 2.49; 95% CI: 1.00 to 6.12; p = 0.050), heart failure (OR: 2.42; 95% CI: 1.72 to 3.41; p < 0.001), stroke (OR: 5.39; 95% CI: 2.76 to 10.53; p < 0.001), acute renal failure (OR: 13.28; 95% CI: 9.08 to 19.42; p < 0.001), pericardial effusion (OR: 5.65; 95% CI: 3.76 to 8.48; p < 0.001), and shock (OR: 45.11; 95% CI: 31.01 to 65.58; p < 0.001).
Conclusions The use of percutaneous LAA closure increased 3.6-fold from 2011 to 2015, with a nonsignificant uptrend of in-hospital mortality rate in this real-world setting. Important predictors of in-hospital death were acute renal failure, pericardial effusion, and ischemic stroke during hospitalization.
↵∗ Drs. Gori and Keller share last authorship.
This work was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503). The authors are responsible for the contents of this publication. Dr. von Bardeleben has received consultancy and lecture honoraria from Abbott Structural Heart. Dr. Wenzel has received consultancy and lecture honoraria from Bayer, Daiichi Sankyo, and Novartis. Dr. Gori has received consultancy and lecture honoraria from Abbott Vascular and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 14, 2019.
- Revision received March 29, 2019.
- Accepted April 3, 2019.
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