Comparative analysis of left atrial appendage closure efficacy and outcomes by CHA2DS2-VASc score group in patients with non-valvular atrial fibrillation

Mingzhong Zhao; Mengxi Zhao; Cody R Hou; Felix Post; Nora Herold; Jens Walsleben; Qingru Yuan; Zhaohui Meng; Jiangtao Yu

doi:10.3389/fcvm.2022.905728

Comparative analysis of left atrial appendage closure efficacy and outcomes by CHA₂DS₂-VASc score group in patients with non-valvular atrial fibrillation

Front Cardiovasc Med. 2022 Jul 22:9:905728. doi: 10.3389/fcvm.2022.905728. eCollection 2022.

Authors

Mingzhong Zhao^{1

2}, Mengxi Zhao³, Cody R Hou⁴, Felix Post⁵, Nora Herold⁵, Jens Walsleben⁵, Qingru Yuan¹, Zhaohui Meng^{2

6}, Jiangtao Yu^{2

5}

Affiliations

¹ Heart Center, Zhengzhou Ninth People's Hospital, Zhengzhou, China.
² Department of Cardiology, Helmut-G.-Walther-Klinikum, Lichtenfels, Germany.
³ Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁴ Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, United States.
⁵ Clinic for General Internal Medicine and Cardiology, Catholic Medical Center Koblenz-Montabaur, Koblenz, Germany.
⁶ Department of Cardiology, Kunming Medical University, Kunming, China.

Abstract

Background: Higher CHA₂DS₂-VASc score is associated with an increased risk of adverse cardio-cerebrovascular events in patients with non-valvular atrial fibrillation (NVAF), regardless of oral anticoagulation (OAC) status. However, whether this association still exists in patients undergoing left atrial appendage closure (LAAC) is unknown. We evaluated the impact of CHA₂DS₂-VASc score on LAAC efficacy and outcomes.

Methods: A total of 401 consecutive patients undergoing LAAC were included and divided into 3 groups based on CHA₂DS₂-VASc score (0-2, 3-4, and ≥5). Baseline characteristics, periprocedural complications, and long-term outcomes were collected and compared across all groups.

Results: There were no significant differences in implantation success, periprocedural complications, and long-term outcomes across all score groups. Kaplan-Meier estimation showed that the cumulative ratio of freedom from all-cause mortality (P = 0.146), cardiovascular mortality (P = 0.519), and non-cardiovascular mortality (P = 0.168) did not differ significantly by CHA₂DS₂-VASc score group. LAAC decreased the risks of thromboembolism and major bleeding, resulting in a relative risk reduction (RRR) of 82.4% (P < 0.001) and 66.7% (P < 0.001) compared with expected risks in the overall cohort, respectively. Subgroup analysis indicated that observed risks of thromboembolism and major bleeding were significantly lower than the expected risks in score 3-4 and score ≥5 groups, respectively. The level of RRR increased with CHA₂DS₂-VASc score (P < 0.001 for trend) for thromboembolism but not for major bleeding (P = 0.2729 for trend).

Conclusion: Patients with higher CHA₂DS₂-VASc score did not experience worse outcomes, which may be partly attributed to more benefits provided by LAAC intervention in such patients compared to those with a low score.

Keywords: CHA2DS2-VASc score; atrial fibrillation; left atrial appendage closure; major bleeding; outcomes; stroke.