Sex differences in the clinical outcomes after left atrial appendage closure: A systematic review and meta-analysis

Waiel Abusnina, Azka Latif, Ahmad Al-abdouh, Mostafa R. Mostafa, Qais Radaideh, Yazeid Alshebani, Ahmad Aboeata, Itsik Ben-Dor, Erin D. Michos, Khagendra Dahal

Research output: Contribution to journalArticlepeer-review


Introduction: Left atrial appendage occlusion (LAAO) has emerged as a reasonable alternative to oral anticoagulation in a selective group of patients with atrial fibrillation (AF). While women are known have higher risk of AF-related stroke, the impact of sex differences on the clinical outcomes of LAAO has not been well studied. Objective: We sought to perform a meta-analysis evaluating sex differences on the outcomes of patients undergoing LAAO. Methods: We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and databases (from inception to October 2021) for studies evaluating the impact of sex difference on LAAO procedural outcomes. We used a random-effect model to calculate risk ratio (RR) with 95% confidence intervals (CI). In-hospital all-cause mortality and ischemic stroke were the primary endpoints. In-hospital pericardial effusion/cardiac tamponade, major bleeding, technical success, device related thrombus and hospital length of stay were secondary outcomes. Results: A total of 5 studies with 54,754 patients were included, of which 22,461 (41%) were females. Female sex was associated with higher rates of in-hospital all-cause mortality (RR 2.18; 95% CI 1.46–3.26; P = 0.0001) and in-hospital ischemic stroke (RR 1.67; 95% CI 1.06–2.61; P = 0.03) when compared with males. Females had higher rates of in-hospital major bleeding (RR 1.93; 95% CI 1.40–2.67; P < 0.0001) and hospital length of stay >1 day (RR 1.38; 95% CI 1.33–1.45; P < 0.00001). There was no differences between females and males in terms of technical success and device related thrombus (RR 1.00; 95% CI 1.00–1.00; P = 1.00) and (RR 0.94, 95% CI 0.31–2.82; P = 0.91), respectively. Conclusion: In conclusion, women are more likely to experience worse periprocedural outcomes with longer hospital stay after LAA closure. Further efforts are needed to increase the participation of women in clinical studies and to assess these differences to properly address the discrepancy in outcomes between men and women.

Original languageEnglish (US)
JournalCardiovascular Revascularization Medicine
StateAccepted/In press - 2021

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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