Systematic review and meta-analysis of left atrial appendage closure's influence on early and long-term mortality and stroke
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Bibliographic record
Abstract
<h2>Abstract</h2><h3>Objective</h3> Left atrial appendage closure (LAAC) concomitant to heart surgery in patients with underlying atrial fibrillation (AF) has gained attention because of long-term reduction of thromboembolic complications. As of mortality benefits in the setting of non-AF, data from both observational studies and randomized controlled trials are conflicting. <h3>Methods</h3> On-line databases were screened for studies comparing LAAC versus no LAAC concomitant to other heart surgery. End points assessed were all-cause mortality and stroke at early and longest-available follow-up. Subgroup analyses stratified on preoperative AF were performed. Risk ratios (RR) with 95% CIs served as primary statistics. <h3>Results</h3> Electronic search yielded 25 studies (N = 660 [158 patients]). There was no difference between LAAC and no LAAC in terms of early mortality. In the overall population analysis, LAAC reduced long-term mortality (RR, 0.86; 95% CI, 0.74-1.00; <i>P</i> = .05; <i>I</i><sup>2</sup> = 88%), reduced early stroke risk by 19% (RR, 0.81; 95% CI, 0.72-0.93; <i>P</i> = .002; <i>I</i><sup>2</sup> = 57%), and reduced late stroke risk by 13% (RR, 0.87; 95% CI, 0.84-0.90; <i>P</i> < .001; <i>I</i><sup>2</sup> = 58%). Subgroup analysis showed lower mortality (RR, 0.85; 95% CI, 0.72-1.01; <i>P</i> = .06; <i>I</i><sup>2</sup> = 91%), short-, and long-term stroke risk reduction only in patients with preoperative AF (RR, 0.81; 95% CI, 0.71-0.93; <i>P</i> = .003; <i>I</i><sup>2</sup> = 71% and RR, 0.87; 95% CI, 0.84-0.91; <i>P</i> < .001; <i>I</i><sup>2</sup> = 70%, respectively). No benefit of LAAC in patients without AF was found. <h3>Conclusions</h3> Concomitant LAAC was associated with reduced stroke rates at early and long-term and possibly reduced all-cause mortality at the long-term follow-up but the benefits were limited to patients with preoperative AF. There is not enough evidence to support routine concomitant LAAC in non-AF settings.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it