TY - JOUR
T1 - Meta-Analysis of the Outcomes of Peri-Device Leak After Left Atrial Appendage Closure
AU - Mostafa, Mostafa Reda
AU - Eid, Mohamed Magdi
AU - Abuelazm, Mohamed
AU - Al-Abdouh, Ahmad
AU - Najim, Mostafa
AU - Hassan, Abdul Rhman
AU - El-Sakka, Amro A.
AU - Renjithal, Sarath Lal Mannumbeth
AU - Malik, Muhammad Ahmed
AU - Mohamed, Sarah
AU - Balmer-Swain, Mallory
AU - Paul, Timir K.
AU - Goldsweig, Andrew M.
N1 - Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/10/1
Y1 - 2023/10/1
N2 - Left atrial appendage closure (LAAC) reduces the risk of thromboembolic stroke in atrial fibrillation. Peri-device leak (PDL) after LAAC may affect the subsequent risk of thromboembolism. We conducted a systematic review and meta-analysis to evaluate the effect of PDL after LAAC. We searched PubMed/Medline, Embase, and Google Scholar for studies reporting outcomes of PDL after LAAC from inception through October 2022. The primary outcome was the composite of stroke, transient ischemic attack (TIA), or systemic embolism (SE). Secondary outcomes included all-cause and cardiovascular mortality, ischemic stroke, TIA, and device-related thrombus. Outcomes were pooled using random-effects models. We used I2 statistics to assess statistical heterogeneity; I2 >50% considered significant heterogeneity. This study included 54,279 patients from 11 studies (6 observational, 2 nonrandomized controlled trials [non-RCTs] primary results, 2 RCT post hoc analyses, and 1 analysis combining 2 RCTs data). PDL was associated with a significant increase in the composite outcome of stroke, TIA, or SE (odds ratio 1.63, 95% confidence interval 1.06 to 2.52, p = 0.03, I2 = 43%) as compared with cases with no PDL. There were no significant differences in all-cause or cardiovascular mortality, ischemic stroke, TIA, or device-related thrombus. In conclusion, PDL after LAAC is associated with an increased risk of thromboembolism (composite stroke, TIA, or SE) without impacting mortality.
AB - Left atrial appendage closure (LAAC) reduces the risk of thromboembolic stroke in atrial fibrillation. Peri-device leak (PDL) after LAAC may affect the subsequent risk of thromboembolism. We conducted a systematic review and meta-analysis to evaluate the effect of PDL after LAAC. We searched PubMed/Medline, Embase, and Google Scholar for studies reporting outcomes of PDL after LAAC from inception through October 2022. The primary outcome was the composite of stroke, transient ischemic attack (TIA), or systemic embolism (SE). Secondary outcomes included all-cause and cardiovascular mortality, ischemic stroke, TIA, and device-related thrombus. Outcomes were pooled using random-effects models. We used I2 statistics to assess statistical heterogeneity; I2 >50% considered significant heterogeneity. This study included 54,279 patients from 11 studies (6 observational, 2 nonrandomized controlled trials [non-RCTs] primary results, 2 RCT post hoc analyses, and 1 analysis combining 2 RCTs data). PDL was associated with a significant increase in the composite outcome of stroke, TIA, or SE (odds ratio 1.63, 95% confidence interval 1.06 to 2.52, p = 0.03, I2 = 43%) as compared with cases with no PDL. There were no significant differences in all-cause or cardiovascular mortality, ischemic stroke, TIA, or device-related thrombus. In conclusion, PDL after LAAC is associated with an increased risk of thromboembolism (composite stroke, TIA, or SE) without impacting mortality.
UR - https://www.scopus.com/pages/publications/85167415655
UR - https://www.scopus.com/pages/publications/85167415655#tab=citedBy
U2 - 10.1016/j.amjcard.2023.07.102
DO - 10.1016/j.amjcard.2023.07.102
M3 - Article
C2 - 37572568
AN - SCOPUS:85167415655
SN - 0002-9149
VL - 204
SP - 325
EP - 332
JO - American Journal of Cardiology
JF - American Journal of Cardiology
ER -