C-54 | Evaluating Outcomes of Percutaneous Left Atrial Appendage Occlusion vs. Direct Oral Anticoagulation in Patients with Atrial Fibrillation Undergoing PCI: A TriNetX-Based Retrospective Analysis

Background: Afib is an extremely common arrhythmia both in the United States (U.S.) and globally.Similarly, the burden of peripheral artery disease (PAD) continues to be on the rise.While PAD has been established to be a coronary heart disease risk equivalent, the impact of PAD on Afib outcomes is limited.Our study aims to evaluate the impact of PAD on outcomes of ablation therapies for Afib.Methods: Utilizing ICD-10 codes for both diagnosis and procedures and the National Inpatient Sample data, we first identified patients who had Afib ablation during the admission.We then identified history of peripheral artery disease (PAD) among the Afib ablation cohort.Utilizing nearest 1 to 1 matching, we built a propensity score model using PAD to adjust for confounding.Primary outcome was inpatient mortality, while secondary outcomes included cardiogenic shock, length of stay and mechanical circulatory support devices.We utilized appropriate test of significance and performed logistic regression on our matched cohort to assess risks of outcomes.Results: We identified a total of 59,820 patient who had Afib ablation among which 2486 had history of PAD.After propensity score matching, our final sample had 4972 patients split between the PAD and non-PAD patients.The mean age was similar among both groups: 70 years + 12 for the non-PAD and 71 + 9 years for the PAD group.More males were represented in the final cohort compared to women (66.21% vs 33.79%).We found that patients without PAD had significantly lower odds of coronary dissection (OR 0.48; CI 0.42 -0.54; P < 0.0001), and mechanical circulatory support use (OR 0.56; CI 0.32 -0.98; P 0.04) compared to patients with PAD.Though odds of in-hospital mortality (OR 0.68; CI 0.44 -1.05; P 0.08) and cardiogenic shock (OR 0.88; CI 0.67 -1.16; P 0.37) was lower among patients without PAD undergoing afib ablation compared to patients with PAD, this wasn't statistically significant.Conclusions: Our study highlights crucial differences in outcomes between Afib ablation outcomes and PAD.More studies is needed to further characterize these differences.