The\u00a0EuroPCR\u00a0Course\u00a0Directors\u00a0have\u00a0selected\u00a03\u00a0major\u00a0late-breaking\u00a0trials\u00a0that will be presented for the first time during\u00a0EuroPCR\u00a02026\u00a0and are set to\u00a0impact practice\u00a0worldwide. Among them is\u00a0a\u00a0subgroup\u00a0analysis of\u00a0the CHAMPION-AF trial\u00a0investigating\u00a0stroke-prevention strategies in patients with atrial fibrillation by age.<\/p>\n
Background\u00a0<\/p>\n
For patients with atrial fibrillation\u00a0(AF), the use of oral anticoagulant therapy to prevent stroke is limited by the risk of bleeding. Left atrial appendage closure\u00a0(LAAC)\u00a0is considered for patients who are unsuitable candidates for long-term anticoagulation, but its role in patients who are eligible for anticoagulants has not been\u00a0established.\u00a0Earlier this year, results were published from the CHAMPION-AF trial comparing\u00a0device-based\u00a0LAAC with direct\u00a0oral anticoagulant (DOAC)\u202ftherapy among patients with\u00a0AF\u00a0who were candidates for anticoagulation.\u00a0The primary efficacy<\/a> endpoint of\u00a0death from\u00a0cardiovascular\u00a0causes, stroke or systemic embolism\u00a0at 3 years was noninferior for LAAC\u00a0vs.\u00a0DOAC therapy, while LAAC was superior to DOAC for the primary safety endpoint of\u00a0non-procedure-related bleeding\u00a0at 3 years.\u00a0<\/p>\n Jens Erik Nielsen-Kudsk\u00a0presented results from a prespecified\u00a0sub analysis\u00a0of the CHAMPION-AF trial, which\u00a0evaluated the efficacy and safety of LAAC vs. DOAC\u00a0by age.<\/p>\n Results\u00a0<\/p>\n The analysis included data from 1,915 patients aged <75 years and 1,085 patients aged \u226575 years.\u00a0 Key\u00a0learnings\u00a0<\/p>\n Conclusions\u00a0and\u00a0PCR\u00a0recommendations\u00a0<\/p>\n These\u00a0findings\u00a0suggest\u00a0that age alone should not\u00a0preclude\u00a0the use of\u00a0LAAC in otherwise suitable candidates.\u00a0It should be noted that caution is needed when interpreting subgroup analyses as they are associated with certain limitations including reduced power compared with the overall analysis.\u00a0The choice between LAAC and DOAC should be\u00a0made on an\u00a0individualised\u00a0basis in a\u00a0shared decision-making\u00a0process\u00a0with patients.\u00a0<\/p>\n Source:<\/p>\n Journal reference:<\/p>\n
\nThe incidence of the primary efficacy endpoint of\u00a0death\u00a0from\u00a0cardiovascular\u00a0causes, stroke or systemic embolism\u00a0at 3 years was similar for LAAC vs. DOAC in patients aged <75 years (hazard ratio [HR]\u00a01.07; 95% confidence interval [CI]\u00a00.67\u20131.71; log rank p=0.7789) and \u226575 years (HR\u00a01.34; 95% CI\u00a00.85\u20132.12; log rank p=0.2036; p\u202finteraction=0.5014).\u00a0
\nSignificantly lower incidence of non-procedural major and clinically relevant non-major bleeding\u00a0was observed with LAAC vs. DOAC in patients aged <75 years (HR 0.64; 95% CI\u00a00.50\u20130.82; log rank p<0.0001) and \u226575 years (HR 0.68; 95% CI\u00a00.51\u20130.91; log rank\u00a0p=0.0002; p\u202finteraction=0.7281).\u00a0
\nIn the\u00a0intention-to-treat\u00a0analysis,\u00a0the incidence of\u00a0ischaemic\u00a0stroke was higher in LAAC vs.\u00a0DOAC,\u00a0but this difference was no longer significant among patients who received their assigned therapy as intended.\u00a0
\nRates of disabling ischaemic stroke were\u00a0very low\u00a0and similar across treatment arms and age groups.\u00a0<\/p>\n