Related Experiment Video
Updated: Oct 6, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Gender-specific outcomes after percutaneous left atrial appendage closure: A nationwide readmission database analysis
Neel Patel1, Sagar Ranka1, Adrija Hajra2
1Department of Cardiology, University of Kansas Medical Center, Kansas City, Kansas, USA.
Insights
Women undergoing percutaneous left atrial appendage closure (pLAAC) for atrial fibrillation (AF) stroke prevention experienced higher peri-procedural complications and readmission risks. Mortality rates were similar between genders during the initial hospital stay.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Atrial fibrillation (AF) poses a significant stroke risk, with thromboembolism being a major concern.
- Percutaneous left atrial appendage closure (pLAAC) is a key intervention for stroke prevention in AF patients unsuitable for anticoagulation.
- Understanding gender-specific outcomes in pLAAC is crucial for optimizing patient care.
Purpose of the Study:
- To investigate potential gender disparities in peri-procedural and readmission outcomes following pLAAC.
- To identify specific complication types that may differ between men and women undergoing pLAAC.
Main Methods:
- Analysis of the National Readmission Database (2016-2018) for AF patients undergoing pLAAC.
- Utilized multivariate logistic regression and time-to-event Cox regression analyses.
- Employed propensity matching (Greedy method) to ensure robust comparison between genders.
Main Results:
- A total of 28,819 patients (41.5% women) were analyzed; women were slightly older on average.
- Women exhibited higher overall peri-procedural complications (8.6% vs. 6.6%), notably bleeding (OR 1.32) and cardiac tamponade (OR 1.80).
- Women faced double the risk of peri-procedural ischemic stroke and increased readmission rates at 30 days (20%) and 6 months (13%) without a difference in mortality.
Conclusions:
- Women experience greater peri-procedural complications and higher readmission risks after pLAAC compared to men.
- No significant difference in mortality was observed during the index hospitalization between genders.
- Further research is warranted to elucidate the underlying causes of these observed gender-based outcome differences.
Introduction:
Thromboembolism-associated stroke is the most feared complication of atrial fibrillation (AF). Percutaneous left atrial appendage closure (pLAAC) is indicated for stroke prevention in patients with AF who can not tolerate long-term anticoagulation. We aim to study gender differences in peri-procedural and readmissions outcomes in pLAAC patients.
Methods:
Using the national readmission database from January 2016 to December 2018, AF patients undergoing the pLAAC procedure were identified. We used multivariate logistic regression analyses and time-to-event Cox regression analyses to conduct the study. Propensity matching with the Greedy method was done for the accuracy of results.
Result:
A total of 28 819 patients were included in our study. Among them 11 946 (41.5%) were women and 16 873 (58.6%) were men. The mean age of overall population was 76.1 ± 8.5 years, with women ~1 year older than men. The overall rate of complications was higher in women (8.6% vs. 6.6%, p < .001), primarily driven by bleeding-related complications, that is, major bleed (odds ratio [OR]: 1.32 95% confidence interval [CI]: 1.03-1.69, p = .029), blood transfusion (OR: 1.45, 95% CI: 1.06-1.97, p = .019), and cardiac tamponade (OR: 1.80, 95% CI: 1.13-2.89, p = .014). Women had two times higher peri-procedural ischemic stroke. There was no difference in peri-procedural mortality. Women remained at 20% and 13% higher risk for readmission at 30 days and 6 months of discharge.
Conclusion:
Women had higher peri-procedural complications and were at higher risk of readmissions at 30 days and 6 months. However, there was no difference in mortality during the index hospitalization. Further studies are necessary to determine causality.
Related Concept Videos
01:21Cardiac Catheterization II: Right Heart Catheterization
01:24Cardiac Catheterization III: Left Heart Catheterization