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Published on: February 26, 2013
Percutaneous Left Atrial Appendage Closure Among Patients With Diabetes (Insights from a National Database)
Mohamed Hamed1, Ramez Morcos2, Ayman Elbadawi3
1Department of Internal Medicine, Florida Atlantic University, Boca Raton, Florida.
Insights
Diabetes mellitus (DM) does not increase adverse events after left atrial appendage closure (LAAC), a stroke prevention therapy. This study found no significant differences in major complications for patients with DM undergoing LAAC.
Area of Science:
- Cardiology
- Vascular Medicine
- Diabetes Research
Background:
- Atrial fibrillation increases stroke risk, making left atrial appendage closure (LAAC) a key alternative to anticoagulation for high-bleeding-risk patients.
- Diabetes mellitus (DM) is linked to poorer outcomes in cardiac procedures, raising concerns about its impact on LAAC.
- Understanding DM's effect on LAAC outcomes is crucial for patient selection and risk management.
Purpose of the Study:
- To compare procedural and hospital outcomes of left atrial appendage closure (LAAC) in patients with and without diabetes mellitus (DM).
- To assess the safety and efficacy of LAAC in a large cohort of patients with atrial fibrillation and varying DM status.
Main Methods:
- A nationwide retrospective analysis of the Nationwide Inpatient Database (2016-2019).
- Inclusion of patients with atrial fibrillation undergoing left atrial appendage closure (LAAC).
- Comparison of adverse events (in-hospital death, MI, stroke, bleeding, etc.) and length of stay between patients with and without DM.
Main Results:
- The study analyzed 62,220 patients, with 34.9% having diabetes mellitus (DM).
- No significant difference in overall adverse events (9.18% vs. 8.77%) or length of stay was observed between patients with and without DM.
- Patients with DM showed a higher incidence of acute kidney injury (3.75% vs. 1.96%).
Conclusions:
- Diabetes mellitus (DM) is not associated with increased adverse event rates following left atrial appendage closure (LAAC).
- LAAC appears to be a safe and effective stroke prevention strategy for atrial fibrillation patients, irrespective of DM status.
- While overall adverse events are similar, heightened vigilance for acute kidney injury in diabetic patients undergoing LAAC is warranted.
Abstract:
Atrial fibrillation is a major risk factor for stroke. Left atrial appendage closure (LAAC) has emerged as an alternative to anticoagulation for patients with high risk of bleeding. Diabetes mellitus (DM) is associated with adverse events after cardiac procedures. We sought to compare procedural and hospital outcomes in patients who underwent LAAC with and without DM. The Nationwide Inpatient Database was queried for patients with atrial fibrillation who underwent LAAC between January 1, 2016, and December 31, 2019. The primary outcome was all adverse events that included in-hospital death, acute myocardial infarction, cardiac arrest, stroke, pericardial effusion, pericardial tamponade, pericardiocentesis, pericardial window, and postprocedural hemorrhage requiring blood transfusion. Analysis included 62,220 patients who underwent LAAC from 2016 to 2019; 34.9% of patients had DM. There was a slight increase in the percentage of patients who underwent LAAC who had DM during the study period, from 29.92% to 34.93%. In unadjusted and adjusted analysis, there was no significant difference in all adverse events between patients with and without DM who underwent LAAC (9.18% vs 8.77%, respectively, adjusted p = 0.63), and no difference in length of stay. Patients with DM have higher risk of acute kidney injury (3.75 vs 1.96%, p <0.001). This nationwide retrospective study demonstrates that DM is not associated with an increase in adverse event rates in patients who underwent LAAC.
