Outcomes of LAA closure vs. DOAC in patients with atrial fibrillation across different age groups

Major LBT from EuroPCR 2026

Summary

This major late-breaking trial from EuroPCR 2026 highlights new insights from the CHAMPION AF study, one of the largest randomised trials comparing left atrial appendage closure (LAAC) with direct oral anticoagulants (DOACs) in patients with atrial fibrillation. In this interview, Philippe Garot and Jens Erik Nielsen-Kudsk discuss the pre-specified age subgroup analysis, showing consistent efficacy across younger and older populations, with significantly lower bleeding rates in the LAAC arm and very high procedural safety. They also explore how these findings could influence future patient selection and expand the role of LAAC in stroke prevention strategies for AF patients.

This interview was filmed at EuroPCR 2026: see more videos here.

Earlier this year, results were published from the CHAMPION-AF trial comparing device-based LAAC with DOAC therapy among 3,000 patients with atrial fibrillation who were candidates for anticoagulation.

The primary efficacy endpoint of death from CV causes, stroke or systemic embolism at 3 years was noninferior for LAAC vs. DOAC therapy, while LAAC was superior to DOAC for the primary safety endpoint of non-procedure-related bleeding at 3 years.

During EuroPCR 2026, Jens Erik Nielsen-Kudsk (Aarhus University Hospital - Aarhus, Denmark) presented results from a prespecified subanalysis that evaluated the efficacy and safety of LAAC vs. DOAC in patients aged <75 years (n=1,915) and ≥75 years (n=1,085).

Results from both age groups were consistent with those observed in the overall analysis.

The incidence of the primary efficacy endpoint was similar for LAAC vs. DOAC in patients aged <75 years (4.0% vs. 3.8%; HR 1.07; 95% CI 0.67–1.71; log rank p=0.7789) and ≥75 years (8.8% vs. 6.6%; HR 1.34; 95% CI 0.85–2.12; log rank p=0.2036; p interaction=0.5014).

Significantly lower incidence of non-procedural ISTH major and modified ISTH clinically relevant non-major bleeding was observed with LAAC vs. DOAC in patients aged <75 years (11.2% vs. 17.2%; HR 0.64; 95% CI 0.50–0.82; log rank p<0.0001) and ≥75 years (15.6% vs. 22.4%; HR 0.68; 95% CI 0.51–0.91; log rank p=0.0002; p interaction=0.7281).

In the ITT analysis, ischaemic stroke was higher in LAAC vs. DOAC in patients aged ≥75 years, but Professor Nielsen-Kudsk remarked that “this difference was no longer significant among patients who received their assigned therapy as intended, suggesting the observed signal is likely influenced by factors beyond the device itself.”

He noted that disabling ischaemic stroke rates were very low (0.2–0.3% per year) and similar across treatment arms and age groups.

Professor Nielsen-Kudsk concluded, “LAAC procedural performance was consistent across age groups, with high implant success and low rates of procedural complications. Our results indicate that age alone should not preclude the use of LAAC in otherwise suitable candidates. The choice between LAAC and DOAC groups with patients.”

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