ISSN: 1885-5857 Impact factor 2023 7.2
Corrected proofs Journal pre-proofs

Original article
Early and late hospital readmissions after percutaneous left atrial appendage closure

Rehospitalizaciones precoces y tardías tras el cierre percutáneo de la orejuela izquierda

Kim Hoang TrinhaJorge NucheaIgnacio Cruz-GonzálezbcPaul GuedeneydDabit ArzamendieXavier FreixafLuis Nombela-FrancogVicente PeralhBerenice Caneiro-QueijaiAntonio MangierijkBlanca Trejo-VelascobLluis AsmaratsePedro Cepas-GuillénafPablo SalinasgJoan Siquier-PadillahRodrigo Estevez-LoureiroiAlessandra LaricchialGilles O’haraaGilles MontalescotdMélanie CôtéaJules MesnieraJosep Rodés-Cabauaf

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10.1016/j.rec.2024.07.009
Abstract
Introduction and objectives

Percutaneous left atrial appendage closure (LAAC) has emerged as a nonpharmacological alternative for the prevention of thromboembolic events in patients with nonvalvular atrial fibrillation. However, there are few data on readmissions after LACC. The aim of this study was to determine the rate of early (≤ 30 days) and late (31-365 days) readmission after LAAC, and to assess the predictors and clinical impact of rehospitalization.

Methods

This multicenter study included 1419 consecutive patients who underwent LAAC. The median follow-up was 33 [17-55] months, and follow-up was complete in all but 54 (3.8%) patients. The primary endpoint was readmissions for any cause. Logistic regression and Cox regression analysis were performed to determine the predictors of readmission and its clinical impact.

Results

A total of 257 (18.1%) patients were readmitted within the first year after LAAC (3.2% early, 14.9% late). The most common causes of readmission were bleeding (24.5%) and heart failure (20.6%). A previous gastrointestinal bleeding event was associated with a higher risk of early readmission (OR, 2.65; 95%CI, 1.23-5.71). The factors associated with a higher risk of late readmission were a lower body mass index (HR, 0.96-95%CI, 0.93-0.99), diabetes (HR, 1.38-95%CI, 1.02-1.86), chronic kidney disease (HR, 1.60; 95%CI, 1.21-2.13), and previous heart failure (HR, 1.69; 95%CI, 1.26-2.27). Both early (HR, 2.12-95%CI, 1.22-3.70) and late (HR, 1.75; 95%CI, 1.41-2.17) readmissions were associated with a higher risk of 2-year mortality.

Conclusions

Readmissions within the first year after LAAC were common, mainly related to bleeding and heart failure events, and associated with patients’ comorbidity burden. Readmission after LAAC confered a higher risk of mortality during the first 2 years after the procedure.

Keywords

Atrial fibrillation
Left atrial appendage closure
Rehospitalization
Readmission

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