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. 2023 May 16:14:1190011.
doi: 10.3389/fneur.2023.1190011. eCollection 2023.

Patent foramen ovale closure in non-elderly and elderly patients with cryptogenic stroke: a hospital-based cohort study

Po-Lin Chen  1   2   3 , Chi-Sheng Wang #  1 , Jin-An Huang  1   3   4 , Yun-Ching Fu  5   6   7 , Nien-Chen Liao  1   8 , Chiann-Yi Hsu  9 , Yu-Hsuan Wu #  1
Affiliations

Patent foramen ovale closure in non-elderly and elderly patients with cryptogenic stroke: a hospital-based cohort study

Po-Lin Chen et al. Front Neurol. .

Abstract

Introduction: The efficacy of patent foramen ovale (PFO) closure in the elderly population is unclear. We aimed to investigate the efficacy and safety of PFO closure in non-elderly and elderly patients.

Methods: Patients over 18 years of age with cryptogenic stroke (CS) or transient ischemic attack and PFO were prospectively enrolled and classified into two groups according to treatment: (1) closure of PFO (the PFOC group) and (2) medical treatment alone (the non-PFOC group). The primary outcome was a composite of recurrent cerebral ischemic events and all-cause mortality during the follow-up period. A modified Ranking Scale [mRS] at 180 days was recorded. The safety outcomes were procedure-related adverse events and periprocedural atrial fibrillation. The results between the PFOC and non-PFOC groups in non-elderly (<60 years) and elderly (≥60 years) patients were compared.

Results: We enrolled 173 patients, 78 (45%) of whom were elderly. During a mean follow-up of 2.5 years, the incidence of primary outcome was significantly lower in the PFOC group (6.2% vs. 17.1%, hazard ratio[HR] = 0.35, 95% CI 0.13-0.97, p = 0.043) in adjusted Cox regression analysis. Compared with the non-PFOC group, the PFOC group had a numerically lower risk of the primary outcome in both the elderly (HR 0.26, 95% CI 0.07-1.01, p = 0.051) and the non-elderly (HR 0.61, 95% CI 0.11-3.27, p = 0.574) groups. In addition, patients with PFO closure in the elderly group had a lower median mRS at 180 days (p = 0.002). The rate of safety outcome was similar between the non-elderly and elderly groups.

Discussion: PFO closure was associated with a reduced risk of the primary outcome in patients with PFO and CS in our total cohort, which included non-elderly and elderly patients. Compared to those without PFO closure, elderly patients with PFO closure had a better functional outcome at 180 days. PFO closure might be considered in selected elderly patients with PFO.

Keywords: cryptogenic stroke; ischemic stroke; outcome; patent foramen ovale; patent foramen ovale closure.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram. AIS, acute ischemic stroke; TIA, transient ischemic attack; LAA, large artery atherosclerosis; SVO, small vessel occlusion; CS, cryptogenic stroke; PEOC, patent foramen ovale closure.
Figure 2
Figure 2
Effect of PFO closure on the risk of recurrent ischemic stroke. PFO, patent foramen ovale; RoPE, risk of paradoxical embolism score; TIA, transient ischemic stroke. aThe hazard ratio PFO closure on small PFO shunt size was not analyzed due to limited sample size. The incidence of the primary outcome in patients with small shunt size and PFOC was 0% in our study, and not available to perform analysis stratified by shunt size.
Figure 3
Figure 3
The rate of recurrent ischemic stroke between PFOC and non-PFOC.
See this image and copyright information in PMC

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