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Original research
Comorbidity burden in patients undergoing left atrial appendage closure
  1. Shubrandu Sanjoy1,
  2. Yun-Hee Choi1,
  3. David Holmes2,
  4. Howard Herrman3,
  5. Juan Terre4,
  6. Chadi Alraies5,
  7. Tomo Ando6,
  8. Nikolaos Tzemos7,
  9. Mamas Mamas8,
  10. Rodrigo Bagur1,7,8
  1. 1 Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
  2. 2 Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  3. 3 Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  4. 4 Division of Cardiology, Albert Einstein College of Medicine, New York, New York, USA
  5. 5 Division of Cardiology, Wayne State University, Detroit, Michigan, USA
  6. 6 Division of Cardiology, Kawasaki Saiwai Hospital, Kawasaki, Japan
  7. 7 Division of Cardiology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University; London Health Sciences Centre, London, Ontario, Canada
  8. 8 Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
  1. Correspondence to Dr Rodrigo Bagur, University Hospital, London Health Sciences Centre, 339 Windermere Rd, London, ON, N6A5A5, Canada; rodrigobagur{at}


Objective To estimate the risk of in-hospital complications after left atrial appendage closure (LAAC) in relationship with comorbidity burden.

Methods Cohort-based observational study using the US National Inpatient Sample database, 1 October 2015 to 31 December 2017. The main outcome of interest was the occurrence of in-hospital major adverse events (MAE) defined as the composite of bleeding complications, acute kidney injury, vascular complications, cardiac complications and postprocedural stroke. Comorbidity burden and thromboembolic risk were assessed by the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Score (ECS) and CHA2DS2-VASc score. MAE were identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes. The associations of comorbidity with in-hospital MAE were evaluated using logistic regression models.

Results A total of 3294 hospitalisations were identified, among these, the mean age was 75.7±8.2 years, 60% were male and 86% whites. The mean CHA2DS2-VASc score was 4.3±1.5 and 29.5% of the patients had previous stroke or transient ischaemic attack. The mean CCI and ECS were 2.2±1.9 and 9.7±5.8, respectively. The overall composite rate of in-hospital MAE after LAAC was 4.6%. Females and non-whites had about 1.5 higher odds of in-hospital AEs as well participants with higher CCI (adjusted OR (aOR): 1.19, 95% CI: 1.13 to 1.24, p<0.001), ECS (aOR: 1.06, 95% CI: 1.05 to 1.08, p<0.001) and CHA2DS2-VASc score (aOR: 1.08, 95% CI: 1.02 to 1.15, p=0.01) were significantly associated with in-hospital MAE.

Conclusion In this large cohort of LAAC patients, the majority of them had significant comorbidity burden. In-hospital MAE occurred in 4.6% and female patients, non-whites and those with higher burden of comorbidities were at higher risk of in-hospital MAE after LAAC.

  • electrophysiology
  • epidemiology
  • stroke
  • atrial arrhythmia ablation procedures

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Twitter @mmamas1973, @RodrigoBagur

  • Contributors SS and RB conceived and designed the study. SS, Y-HC and RB analysed, interpreted the data and drafted the first version of the manuscript. All authors have interpreted the data, critically revised, provided intellectual contributions and approved the final version of the manuscript. RB is the guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding SSS received partial funding for his MSc studies from a Lawson Health Research Institute Internal Research Fund (studentship award). This work will be a partial fulfilment material towards SSS’s Master of Sciences degree, Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.

  • Competing interests DH is on the Advisory Board for Boston Scientific, unpaid.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.