Ischemic outcomes after left atrial appendage closure following intracerebral hemorrhage: a retrospective inverse probability weighting analysis from the HANSE-LAAC registry.

Abstract

Background: Intracerebral hemorrhage (ICH) is associated with worse outcomes and subsequent high risk for acute arterial ischemic events. Percutaneous left atrial appendage closure (LAAC) is an established procedure in case of atrial fibrillation and adverse events, such as severe bleeding. Clinical benefits of LAAC in patients with ICH are currently unclear.

Methods: The single-center registry HANSE-LAAC included consecutively treated patients from 2014 to 2022. Index-procedure and standardized follow-ups at 3 and 12 months were analyzed regarding safety and efficacy retrospectively. Mortality, major adverse cardiovascular, and bleeding events were compared between patients with or without ICH. We used Cox proportional hazard models and inverse probability weights to adjust confounders.

Results: 401 patients received percutaneous LAAC (ICH 15.2%, n = 61 and non-ICH 84.8%, n = 340). The composite endpoint of death, MACE, and bleeding was significantly lower in the ICH group (HR 0.35, confidence interval [CI] 0.05-4.62, p = 0.0044). This clinical benefit was mainly driven by a significant reduction in bleeding events (HR 0.27; CI 0.06-1.15, p = 0.04). Re-hospitalization was significantly lower as well (HR 0.36; CI 0.20-0.64, p < 0.0001). Adjustment for confounders and inverse probability weighting for the probability of ICH showed no statistically significant difference in mortality (HR 0.53, CI 0.15-1.92, p = 0.33), stroke (HR 0.32 CI 0.03-3.13, p = 0.33), bleeding (HR 0.26; CI 0.05-1.29, p = 0.02), and MACE (HR 0.29; CI 0.04-2.36, p = 0.002).

Conclusion: LAAC in ICH was safe and associated with less MACE, bleeding, and re-hospitalization. Randomized-controlled trials are needed to confirm these first positive signs.