Assessment of patent foramen ovale closure in elderly patients with cryptogenic transient ischemic attack or stroke: Efficacy, safety, and potential age-related benefit.

IF 4.5 3区 医学 Q1 CLINICAL NEUROLOGY
Chi-Sheng Wang, Yu-Hsuan Wu, Yun-Ching Fu, Sheng-Ling Jan, Ming-Chih Lin, Chiann-Yi Hsu, Po-Lin Chen
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引用次数: 0

Abstract

Introduction: The efficacy and safety of patent foramen ovale closure (PFOC) in cryptogenic stroke (CS) patients aged ⩾ 60 remain controversial. This study evaluates the efficacy and safety of PFOC in elderly (aged ⩾ 60) versus non-elderly (aged < 60) patients and examines potential age-related benefit.

Patients and methods: A hospital-based cohort study (January 2013-June 2023) compared the efficacy and safety between PFOC and non-PFOC groups in patient with CS or cryptogenic TIA. The primary efficacy outcome was recurrent ischemic stroke, and safety outcomes included procedure-related adverse events and periprocedural atrial fibrillation (AF). Subgroup analyses, including various age ranges, were performed for the elderly group.

Results: Among 239 patients (mean age 57.2 years), 120 were elderly. During a mean follow-up of 3.1 years, the PFOC group had significantly fewer recurrent ischemic stroke than the non-PFOC group (adjusted hazard ratio (AHR): 0.10, 95% CI: 0.03-0.29, p = 0.001). The risk reduction was similar in elderly (AHR: 0.11, p = 0.004) and non-elderly (AHR: 0.10, p = 0.005) patients (p for interaction = 0.337). Safety outcomes were comparable across age groups, including younger elderly (60-70) and older elderly (⩾70). No life-threatening complications occurred; one patient required additional intervention. Subgroup analysis indicated significant risk reduction for patients aged ⩾ 65 (AHR: 0.01, p = 0.012) but not for those aged 60-65 (AHR: 0.24, p = 0.071).

Discussion and conclusion: PFO closure is safe and effective in elderly patients with CS. Advanced age should not be a contraindication for PFOC, as older patients may potentially derive more significant benefits from the procedure.

评估老年隐源性短暂性脑缺血发作或脑卒中患者卵圆孔未闭闭合:有效性、安全性和潜在的年龄相关获益
在年龄大于或小于60岁的隐源性卒中(CS)患者中,卵圆孔未闭闭合(PFOC)的有效性和安全性仍然存在争议。该研究评估了PFOC在老年人(年龄大于或小于60岁)与非老年人(老年患者和方法:一项基于医院的队列研究(2013年1月- 2023年6月)中与CS或隐源性TIA患者的PFOC组和非PFOC组之间的疗效和安全性。主要疗效终点是缺血性卒中复发,安全性终点包括手术相关不良事件和手术期心房颤动(AF)。对老年组进行亚组分析,包括不同年龄范围。结果:239例患者(平均年龄57.2岁)中,老年人120例。在平均3.1年的随访期间,PFOC组的缺血性卒中复发率明显低于非PFOC组(校正风险比(AHR): 0.10, 95% CI: 0.03-0.29, p = 0.001)。老年患者(AHR: 0.11, p = 0.004)和非老年患者(AHR: 0.10, p = 0.005)的风险降低相似(相互作用p = 0.337)。安全结果在不同年龄组具有可比性,包括较年轻的老年人(60-70岁)和较年长的老年人(大于或等于70岁)。未发生危及生命的并发症;一名患者需要额外的干预。亚组分析表明,小于或等于65岁患者的风险显著降低(AHR: 0.01, p = 0.012),但60-65岁患者的风险没有显著降低(AHR: 0.24, p = 0.071)。讨论与结论:PFO闭合治疗老年CS是安全有效的。高龄不应成为PFOC的禁忌症,因为老年患者可能从该手术中获得更显著的益处。
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来源期刊
CiteScore
7.50
自引率
6.60%
发文量
102
期刊介绍: Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
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