Frontiers in Neurology (May 2023)

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

  • Po-Lin Chen,
  • Po-Lin Chen,
  • Po-Lin Chen,
  • Chi-Sheng Wang,
  • Jin-An Huang,
  • Jin-An Huang,
  • Jin-An Huang,
  • Yun-Ching Fu,
  • Yun-Ching Fu,
  • Yun-Ching Fu,
  • Nien-Chen Liao,
  • Nien-Chen Liao,
  • Chiann-Yi Hsu,
  • Yu-Hsuan Wu

DOI
https://doi.org/10.3389/fneur.2023.1190011
Journal volume & issue
Vol. 14

Abstract

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IntroductionThe 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.MethodsPatients 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.ResultsWe 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.DiscussionPFO 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.

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