Left Atrial Appendage Occlusion May Lower Stroke Severity

Researchers conducted a post hoc exploratory analysis of the multinational LAAOS III randomized clinical trial and included more than 4800 participants (mean age, 71 years; 67.5% male; 80% receiving oral coagulation therapy). All had atrial fibrillation and a CHA₂DS₂-VASc score ≥ 2 and underwent cardiac surgery between 2012 and 2018.
Participants were randomly assigned to receive either surgical LAAO plus standard care (LAAO group) or standard care alone (control group), with a mean follow-up of 3.8 years.
The primary outcome was the occurrence of ischemic stroke or systemic embolism. Secondary outcomes included functional status, measured using modified Rankin Scale (mRS) scores on day 7 or at discharge, and 30-day mortality.

About 273 participants had a first ischemic stroke during follow‑up. The LAAO group had a lower risk for first ischemic stroke than the control group (5% vs 7%, respectively; hazard ratio [HR], 0.66) and a lower proportion of ischemic strokes of presumed cardioembolic etiology than the control group (43% vs 58%; P = .01).
Among those with first ischemic stroke, disability on day 7 or at discharge was lower in the LAAO group than in the control group (median mRS score, 2 vs 3, respectively; odds ratio [OR], 0.80). Cortical infarcts were also less frequent in the LAAO group (46% vs 61%; P = .01).
About 19% of participants died within 30 days of their ischemic stroke event. Risk for 30‑day stroke mortality was lower in the LAAO group than in the control group (16.5% vs 20%; HR, 0.55).
Time-to-event analysis also showed a lower risk for first cardioembolic stroke in the LAAO group (2% vs 4%; HR, 0.47). Sensitivity analysis confirmed the main findings, including lower disability (OR, 0.77) and lower 30-day mortality (14% vs 21%; HR, 0.45) in patients with vs without LAAO.

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