Angelika Eichelmann MD, Ralf Kubini MD, Dejan Nachoski MD, Christoph Kosinski MD, Michael Becker MD, Ali Aljalloud MD
{"title":"对 60 岁以上患者进行卵圆孔闭合术与药物治疗,并进行 5 年随访。","authors":"Angelika Eichelmann MD, Ralf Kubini MD, Dejan Nachoski MD, Christoph Kosinski MD, Michael Becker MD, Ali Aljalloud MD","doi":"10.1002/clc.24251","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>The advantages of patent foramen ovale (PFO) closure as protection from a recurrence of stroke remains controversial compared to drug therapy, especially in patients over 60 years.</p>\n </section>\n \n <section>\n \n <h3> Hypothesis</h3>\n \n <p>The aim of the study is to compare recurrence of stroke in patients over 60 years old with PFO closure versus drug therapy alone.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We included 342 patients over 60 years who suffered a crytopgenic stroke, and were also accepted for a PFO closure. 199 patients refused a PFO closure and were treated with medical therapy alone, whereas 143 patients underwent a PFO closure procedure.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The mean follow up time was 5.5 ± 1.5 years. All patients in Group B showed persistent shunt in the follow-up period (<i>n</i> = 199, 100%). In Group A, seven patients were diagnosed with residual shunt during echocardiography examination (5%). A new onset of atrial fibrillation occurred in seven patients in Group A (5%) and six patients in Group B (3%), <i>p</i> = .117. Recurrent stroke occurred in 3 patients in Group A (2%) and 11 patients in Group B (6%), <i>p</i> = .021. One patient died of unknown reason (1%) and two patients were lost due to neurological death (1%) in Group B, whereas no patients in Group A died during the follow-up period.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Our results show that strict exclusion of patients over 60 years from PFO closure should be reconsidered. As life expectancies are increasing, patients should be considered for same treatment as younger patients, since the outcomes are improved compared to patients treated with medical therapy alone.</p>\n </section>\n </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":null,"pages":null},"PeriodicalIF":2.4000,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24251","citationCount":"0","resultStr":"{\"title\":\"Patent foramen ovale closure versus drug therapy in patients over 60 years and a follow-up of 5 years\",\"authors\":\"Angelika Eichelmann MD, Ralf Kubini MD, Dejan Nachoski MD, Christoph Kosinski MD, Michael Becker MD, Ali Aljalloud MD\",\"doi\":\"10.1002/clc.24251\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>The advantages of patent foramen ovale (PFO) closure as protection from a recurrence of stroke remains controversial compared to drug therapy, especially in patients over 60 years.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Hypothesis</h3>\\n \\n <p>The aim of the study is to compare recurrence of stroke in patients over 60 years old with PFO closure versus drug therapy alone.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>We included 342 patients over 60 years who suffered a crytopgenic stroke, and were also accepted for a PFO closure. 199 patients refused a PFO closure and were treated with medical therapy alone, whereas 143 patients underwent a PFO closure procedure.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>The mean follow up time was 5.5 ± 1.5 years. All patients in Group B showed persistent shunt in the follow-up period (<i>n</i> = 199, 100%). In Group A, seven patients were diagnosed with residual shunt during echocardiography examination (5%). A new onset of atrial fibrillation occurred in seven patients in Group A (5%) and six patients in Group B (3%), <i>p</i> = .117. Recurrent stroke occurred in 3 patients in Group A (2%) and 11 patients in Group B (6%), <i>p</i> = .021. One patient died of unknown reason (1%) and two patients were lost due to neurological death (1%) in Group B, whereas no patients in Group A died during the follow-up period.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Our results show that strict exclusion of patients over 60 years from PFO closure should be reconsidered. 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Patent foramen ovale closure versus drug therapy in patients over 60 years and a follow-up of 5 years
Background
The advantages of patent foramen ovale (PFO) closure as protection from a recurrence of stroke remains controversial compared to drug therapy, especially in patients over 60 years.
Hypothesis
The aim of the study is to compare recurrence of stroke in patients over 60 years old with PFO closure versus drug therapy alone.
Methods
We included 342 patients over 60 years who suffered a crytopgenic stroke, and were also accepted for a PFO closure. 199 patients refused a PFO closure and were treated with medical therapy alone, whereas 143 patients underwent a PFO closure procedure.
Results
The mean follow up time was 5.5 ± 1.5 years. All patients in Group B showed persistent shunt in the follow-up period (n = 199, 100%). In Group A, seven patients were diagnosed with residual shunt during echocardiography examination (5%). A new onset of atrial fibrillation occurred in seven patients in Group A (5%) and six patients in Group B (3%), p = .117. Recurrent stroke occurred in 3 patients in Group A (2%) and 11 patients in Group B (6%), p = .021. One patient died of unknown reason (1%) and two patients were lost due to neurological death (1%) in Group B, whereas no patients in Group A died during the follow-up period.
Conclusion
Our results show that strict exclusion of patients over 60 years from PFO closure should be reconsidered. As life expectancies are increasing, patients should be considered for same treatment as younger patients, since the outcomes are improved compared to patients treated with medical therapy alone.
期刊介绍:
Clinical Cardiology provides a fully Gold Open Access forum for the publication of original clinical research, as well as brief reviews of diagnostic and therapeutic issues in cardiovascular medicine and cardiovascular surgery.
The journal includes Clinical Investigations, Reviews, free standing editorials and commentaries, and bonus online-only content.
The journal also publishes supplements, Expert Panel Discussions, sponsored clinical Reviews, Trial Designs, and Quality and Outcomes.