Left atrial appendage occlusion (LAAO) shows similar benefit to both elderly and younger patients, new data shows. Samian Sulaiman, MD, of West Virginia University, reported these findings Monday during a Featured Clinical Science presentation at Cardiovascular Research Technologies (CRT) 2023 in Washington, D.C. A manuscript reporting these results has been accepted for publication in JACC: Cardiovascular Electrophysiology. The mean age of patients in the PROTECT AF registry was 71.7 ± 8.8 years and the PREVAIL registry patients’ mean age was 74.0 ± 7.4 years. One out of three patients in a national cohort between 2015 and 2018, however, were ≥80 years old. The authors of this study estimated octogenarians are underestimated in these trial types. This study examined 2,258 patients from PROTECT AF and PREVAIL (the randomized trials), and CAP and CAP2 (non-randomized continuous access registries). Roughly 25% (n = 472, 42.20% female, 95.3% Caucasian,) of the patients were ≥80 years, while the other 1,404 patients (31.9% female, 92.0% Caucasian) were <80 years old. The primary endpoints of this study included a composite of cardiovascular (CV)/unknown death, stroke or systemic embolism (SE). The primary safety endpoints included 7-day procedural complications, such as all-cause death, CV death, pericardial effusion that required surgery or any of the primary endpoints. The ≥80-year-old group had a 25.3% rate of CV/unknown death, stroke or SE, which was significantly higher than the <80-year-old group (12%; p < 0.0001). The ≥80-year-old group had a 38.8% all-cause death, which was also significantly higher than the <80-year-old group (14.3%; p < 0.0001). Because these results did not account for age-expected worse outcomes, the investigators of this study created control groups in each age category. After these results, the difference in the primary composite outcome between age groups was no longer statistically significant (p=0.48, p-value for interaction = 0.63). The investigators then followed up with a sensitivity/ competing risk analysis to account for the higher mortality rates in the ≥80-year-old group, after which the differences between the age groups were no longer statistically significant. The investigators also used propensity-score matching as a different way to adjust for comorbidities, which also led to the difference not being statistically significant. The same true for the 7-day safety endpoints. The complete-seal success rates were similar in both age groups at all follow-up points: (45-day rate: younger 98.2% vs. older 97.8%, p = 0.78; 6-month: 98.9% vs. 97.0%, p = 0.30; 12-month 99.2% vs. 99.5%, p = 1.00). Patients with atrial fibrillation experience 91% of clots in the LAA and the success rate is similar between the age groups, so the investigators concluded that it makes sense that LAAO has a similar effect in both age groups. Kapadia noted that despite the study investigators’ extensive statistical adjustment, residual confounding cannot be ruled out. Overall, raw event rates do not necessarily determine the benefits received from LAAO by elderly compared with younger patients. The investigators noted that age should not be the only factor in determining whether to use LAAO. Image Credit: Jason Wermers/CRTonline.org