Patients with T2DM undergoing TAVR demonstrate higher risks of all‐cause mortality, MACCE, and HF exacerbation compared to their counterparts without T2DM.
The T2DM cohort also demonstrated higher all‐cause readmissions, mechanical ventilation, and renal replacement therapy compared to patients without T2DM.
Further studies evaluating the effects of optimizing T2DM control on TAVR outcomes are warranted.
Hritvik Jain, Nandan Patel, M. Naveed et al.· Catheterization and cardiova...· 0 citations
BACKGROUND
Percutaneous left atrial appendage occlusion (LAAO) is an alternative strategy for stroke prevention in patients with nonvalvular atrial fibrillation (AF) with contraindications to long-term oral anticoagulation therapy. However, evidence comparing the long-term outcomes of LAAO with those of direct oral anticoagulants (DOAC) remains limited.
METHODS
A systematic search was conducted across PubMed, Scopus, and the Cochrane databases through April 2026. Co-primary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE; composite of cardiac death, stroke, or systemic embolism) and net adverse clinical events (NACE; composite of MACCE and non-procedure-related bleeding). Secondary endpoints included individual components of co-primary endpoints, ischemic and hemorrhagic stroke, all-cause death, major or clinically significant bleeding (procedure + non-procedure related), and stroke or systemic embolism. The random-effects model was used to generate risk ratios (RRs) and 95% CIs.
RESULTS
Four randomized controlled trials comprising 5890 AF patients and a median follow-up of 3 years were included. There was no significant difference between LAAO and DOAC therapy in the risk of MACCE (RR 1.17; 95%CI 0.96-1.41; I2 = 0%) or NACE (RR 0.89; 95%CI 0.65-1.24; I2 = 85%). Both LAAO and DOAC therapy were similar in risk of cardiac death, stroke, systemic embolism, hemorrhagic stroke, ischemic stroke, all-cause mortality, stroke or systemic embolism, and pericardial effusion. LAAO was associated with a lower risk of non-procedure-related bleeding (RR 0.60; 95%CI 0.47-0.76; I2 = 59%).
CONCLUSION
LAAO demonstrated efficacy comparable to DOAC therapy in reducing the risk of MACCE, NACE, and ischemic events, while significantly reducing the risk of non-procedure-related bleeding. Our findings support a tailored approach to stroke prevention in AF, wherein LAAO serves as an effective alternative for patients with contraindications to DOAC therapy.
Chidubem Ezenna, Khalid Sawalha, Sammudeen Ibrahim et al.· Pacing and clinical electrop...· 0 citations
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