CONGRESS ABSTRACT

Background Left atrial appendage closure (LAAC) has emerged as an effective alternative to oral anticoagulation for stroke prevention in patients with atrial fibrillation. However, the impact of baseline comorbidity burden on procedural and clinical outcomes remains incompletely characterized. The Charlson Comorbidity Index (CCI) is a validated tool for quantifying patient comorbidity load and predicting mortality risk. Aims This study aimed to evaluate the impact of the CCI on clinical and procedural outcomes in patients undergoing percutaneous LAAC. Methods This single-center retrospective study enrolled 169 consecutive patients who underwent LAAC procedures in our Institute, between January 2022 and June 2025. Patients were stratified into 2 groups based on the mean CCI score (≤4.80 vs >4.80). Primary endpoints included major complications, any bleeding events and procedural complications. Results Of 169 patients analyzed, 92 (54.4%) had CCI ≤4.80 and 77 (45.6%) had CCI >4.80. Patients with higher CCI were older (79.9±5.7 vs 77.0±7.1 years, p=0.006) and with higher prevalence of hypertension (75% vs 60%, p=0.048). Patients with CCI >4.80 demonstrated significantly higher rates of any bleeding events (13.0% vs 2.2%, p=0.013; OR=6.72, 95%CI: 1.42-31.67) and procedural complications (13.0% vs 3.3%, p=0.022; OR=4.43, 95%CI: 1.17-16.72). A trend toward increased major complications was observed (31.2% vs 19.6%, p=0.119; OR=1.86, 95%CI: 0.92-3.77). Individual outcomes showed higher rates in the high CCI group for stroke (25.0% vs 18.5%), major bleeding (3.9% vs 0.0%), cardiac tamponade (5.2% vs 1.1%) and blood transfusion (9.3% vs 5.3%). Procedural parameters revealed a trend toward longer procedure times in the high CCI group (77.9±28.2 vs 70.3±24.2 minutes, p=0.065) and increased length of stay (3.9±4.4 vs 3.1±1.8 days, p=0.111). Procedural success rates remained high in both groups (97.4% vs 100%, p=0.209). Conclusions The CCI significantly impacts clinical outcomes in patients undergoing LAAC procedures. Patients with CCI >4.80 demonstrate a 6.7-fold increased risk of bleeding events and a 4.4-fold increased risk of procedural complications. Despite higher comorbidity burden, procedural success rates remain excellent (>97%). These findings suggest that CCI can serve as a valuable risk stratification tool for patient selection, procedural planning and post-procedural monitoring in LAAC procedures.