Sex differences on outcomes following left atrial appendage occlusion in atrial fibrillation: A systematic review and meta-analysis.
Yuansong ZhuBryan Richard SasmitaYuzhou XueYi JiangBi HuangSuxin LuoPublished in: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (2022)
There is a lack of sufficient data on sex-related differences in outcomes of nonvalvular atrial fibrillation (AF) patients following left atrial appendage occlusion (LAAO). We conducted a meta-analysis to investigate the procedural complications and long-term outcomes after LAAO in women versus men. We screened Medline, EMBASE, Cochrane Center Register of Controlled Trials, and Clinical Trials.gov. The inclusion criteria were studies targeting the sex-related differences in outcomes in nonvalvular AF patients treated by LAAO. Procedural endpoints of interest included success rate, pericardial complications, major bleeding, and vascular complications during hospitalization. Long-term outcomes included all-cause mortality and ischemic stroke during follow-up. Studies that merely considered sex in the subgroup analysis were not included. Six observational studies with a total of 64,035 patients were identified. The procedural success rates did not differ between sexes (odds ratio [OR]: 0.98, 95% confidence interval [CI]: 0.89-1.09, p = 0.77), while women experienced more pericardial complications (OR: 1.78, 95% CI: 1.58-2.01, p < 0.00001), major bleedings (OR: 2.04, 95% CI: 1.75-2.39, p < 0.00001), and vascular complications (OR: 1.75, 95% CI: 1.41-2.17, p < 0.00001) than men. The sensitivity analysis performed by removing the largest study showed good stability. The long-term mortality and stroke rates did not differ between women and men in either the 1-year subgroup or the 2-year subgroup. In conclusion, despite comparable procedural success rates, women have a significantly higher incidence of pericardial complications, major bleeding, and vascular complications following LAAO. The long-term mortality and stroke rates do not differ between the sexes.
Keyphrases
- atrial fibrillation
- left atrial appendage
- catheter ablation
- risk factors
- oral anticoagulants
- left atrial
- direct oral anticoagulants
- end stage renal disease
- polycystic ovary syndrome
- heart failure
- ejection fraction
- chronic kidney disease
- newly diagnosed
- clinical trial
- percutaneous coronary intervention
- peritoneal dialysis
- prognostic factors
- randomized controlled trial
- middle aged
- acute coronary syndrome
- type diabetes
- patient reported outcomes
- adipose tissue
- cardiovascular disease
- machine learning
- venous thromboembolism
- artificial intelligence
- insulin resistance
- data analysis
- weight loss