Impact of percutaneous left atrial appendage occlusion on the severity of ischemic stroke.

Background: Percutaneous left atrial appendage occlusion (pLAAO) presents an alternative to anticoagulation (AC) for stroke prophylaxis in atrial fibrillation (Afib) patients with high bleeding risk. pLAAO was associated with lower rates of disabling stroke which was mainly attributed to the reduction of hemorrhagic stroke (HS). Little is known about the impact of pLAAO on the severity of ischemic strokes which we sought to study.

Methods: The study is a retrospective analysis of the National Readmission Database for the years 2016-2020. All 6-month readmissions with IS after pLAAO admissions were identified. The control group comprised patients with Afib on AC who were admitted for IS. Patients with intracranial hemorrhage or those who underwent surgical LAAO were excluded. A propensity score matching system was utilized to match both groups. Treatment effects were presented as percentages and odds ratio (OR) with 95 % confidence interval (CI).

Results: A total of 342 observations in each group were matched (weighted estimate: 583 in the pLAAO group and 663 in the control group). pLAAO group was associated with a decreased risk of fatal stroke (5.1 % vs. 10.0 %, OR: 0.48, 95 % CI [0.26-0.88], P = 0.018), and a decreased risk of non-fatal severe stroke (50.5 % vs. 59.6 %, OR: 0.69, 95 % CI [0.50-0.96], P = 0.029) at 6 months follow-up.

Conclusion: Compared with patients on AC, patients with pLAAO admitted with ischemic strokes are less likely to have severe and fatal stroke. Further studies are needed to validate our findings.