Abstract 594 Sex-related differences in outcome after left atrial appendage occlusion: Insights from Europe and the EWOLUTION Registry

Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Sex-related differences in outcome after left atrial appendage occlusion: Insights from Europe and the EWOLUTION Registry
C. Paitazoglou¹, I. Eitel¹, T. Stiermaier¹, H. Ince², S. Kische³, T. Schmitz⁴, B. Schmidt⁵, T. Gori⁶, F. Meincke⁷, E. Vireca⁸, P. Wohlmuth⁹, L. Boersma¹⁰, M. W. Bergmann¹¹, für die Studiengruppe: EWOLUTION
¹Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck; ²Klinik für Innere Medizin, Kardiologie und konservative Intensivmedizin, Vivantes Klinikum Am Urban, Berlin; ³Klinik für Innere Medizin - Kardiologie und konserv. Intensivmedizin, Vivantes Klinikum im Friedrichshain, Berlin; ⁴Klinik für Kardiologie und Angiologie, Elisabeth-Krankenhaus Essen GmbH, Essen; ⁵Agaplesion Markus Krankenhaus, Frankfurt am Main; ⁶Zentrum für Kardiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz; ⁷3. Med. Abteilung - Kardiologie, Pneumologie und Internistische Intensivmedizin, Asklepios Klinik Altona, Hamburg; ⁸Boston Scientific Corporation, Diegem, Belgium, Machelen, BE; ⁹Asklepios Proresearch, Hamburg; ¹⁰St. Antonius Hospital (St. Antonius Ziekenhuis Nieuwegein), CM Nieuwegein, NL; ¹¹3. Med. Abteilung - Kardiologie und Internistische Intensivmedizin, Asklepios Klinik Altona, Hamburg;
Background Women with atrial fibrillation (AF) generally experience worse symptoms, poorer quality of life and have a higher risk of stroke and death. There is limited availability of sex-related differences regarding LAA occlusion (LAAO). Aims The aim of this study was to evaluate the sex-related differences in patients undergoing LAAO in EWOLUTION. Methods A total of 1025 patients scheduled for elective LAAO therapy employing the WATCHMAN Gen 2.5 prospectively consented for participation; 1005 patients received a successful implant and were followed for two years. As we detected sex-related differences in baseline data we performed a propensity score matching. The primary endpoint is a combined endpoint of overall survival, major bleeding, ischemic stroke, TIA and systemic embolization (SE) up to 2-year clinical follow-up. Secondary Endpoints were peri-procedural data and overall 2-year survival. Results Women were older but had less often vascular disease and haemorrhagic stroke. There was no sex-related significant difference after LAAO at 2 years in the combined endpoint of overall survival, major bleeding, ischemic stroke, TIA and SE (female vs. male: 79% vs.76%, p=0.24) or in overall survival (female vs. male: 85%vs.82%, p=0.16). Procedural data showed a higher sealing rate after the implantation in women (complete sealing female 94% vs. male 90%, p=0.033), significantly more pericardial effusions (female 1.2% vs. male 0.2%,p=0.031) and a similar periprocedural risk profile. Conclusions: Females undergoing LAAO differ in various baseline variables, but after adjustment we observed similar safety and efficacy of LAAO with no significant difference in long-term outcomes between women and men.
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