Julio I Farjat-Pasos, Paul Guedeney, Eric Horlick, Jeremie Abtan, Luis Nombela-Franco, Benjamin Hibbert, Lars Sondergaard, Xavier Freixa, Jean-Bernard Masson, Ignacio Cruz-González, Rodrigo Estévez-Loureiro, Laurent Faroux, Ashish H Shah, Lusine Abrahamyan, Jules Mesnier, Adrián Jerónimo, Omar Abdel-Razek, Troels Højsgaard Jørgensen, Mike Al Asmar, Samuel Sitbon, Mohammed Abalhassan, Mathieu Robichaud, Christine Houde, Mélanie Côté, Angel Chamorro, Sylvain Lanthier, Steve Verreault, Gilles Montalescot, Josep Rodés-Cabau
{"title":"老年患者卵圆孔闭合术后不良后果的决定因素。","authors":"Julio I Farjat-Pasos, Paul Guedeney, Eric Horlick, Jeremie Abtan, Luis Nombela-Franco, Benjamin Hibbert, Lars Sondergaard, Xavier Freixa, Jean-Bernard Masson, Ignacio Cruz-González, Rodrigo Estévez-Loureiro, Laurent Faroux, Ashish H Shah, Lusine Abrahamyan, Jules Mesnier, Adrián Jerónimo, Omar Abdel-Razek, Troels Højsgaard Jørgensen, Mike Al Asmar, Samuel Sitbon, Mohammed Abalhassan, Mathieu Robichaud, Christine Houde, Mélanie Côté, Angel Chamorro, Sylvain Lanthier, Steve Verreault, Gilles Montalescot, Josep Rodés-Cabau","doi":"10.4244/EIJ-D-24-00156","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Limited data are available on transcatheter patent foramen ovale (PFO) closure outcomes in the elderly.</p><p><strong>Aims: </strong>Through this study, we aimed to determine the incidence and predictors of adverse events (recurrent cerebrovascular events [CVE] and atrial fibrillation [AF]) post-PFO closure in older patients with cryptogenic events.</p><p><strong>Methods: </strong>This multicentre international study included patients over 60 years undergoing PFO closure for cryptogenic thromboembolic events. A dedicated database compiled baseline, procedural, and follow-up data. Competing risk and adjusted outcome predictor analyses were conducted.</p><p><strong>Results: </strong>A total of 689 patients were included (median age 65 years, 41.2% female, mean Risk of Paradoxical Embolism [RoPE] score 4.5). The procedural success rate was 99.4%. After a median follow-up of 2 (interquartile range 1-5) years, 66 patients (9.6%) had died. CVE and stroke rates were 1.21 and 0.55 per 100 patient-years, respectively. Diabetes (hazard ratio [HR] 3.89, 95% confidence interval [CI]: 1.67-9.07; p=0.002) and atrial septal aneurysm (ASA; HR 5.25, 95% CI: 1.56-17.62; p=0.007) increased the CVE risk. New-onset AF occurred at a rate of 3.30 per 100 patient-years, with 51.3% within one month post-procedure. Older age (HR 1.05 per year, 95% CI: 1.00-1.09; p=0.023) and the absence of hypertension (HR 2.04, 95% CI: 1.19-3.57; p=0.010) were associated with an increased risk of AF.</p><p><strong>Conclusions: </strong>Older patients undergoing PFO closure had a relatively low rate of CVE and new-onset AF after a median follow-up of 2 years. The presence of diabetes, ASA, and a more advanced age determined an increased risk of adverse clinical events. These factors may be considered in the clinical decision-making process regarding PFO closure in this challenging population.</p>","PeriodicalId":54378,"journal":{"name":"Eurointervention","volume":"20 16","pages":"1029-1038"},"PeriodicalIF":7.6000,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11317834/pdf/","citationCount":"0","resultStr":"{\"title\":\"Determinants of adverse outcomes following patent foramen ovale closure in elderly patients.\",\"authors\":\"Julio I Farjat-Pasos, Paul Guedeney, Eric Horlick, Jeremie Abtan, Luis Nombela-Franco, Benjamin Hibbert, Lars Sondergaard, Xavier Freixa, Jean-Bernard Masson, Ignacio Cruz-González, Rodrigo Estévez-Loureiro, Laurent Faroux, Ashish H Shah, Lusine Abrahamyan, Jules Mesnier, Adrián Jerónimo, Omar Abdel-Razek, Troels Højsgaard Jørgensen, Mike Al Asmar, Samuel Sitbon, Mohammed Abalhassan, Mathieu Robichaud, Christine Houde, Mélanie Côté, Angel Chamorro, Sylvain Lanthier, Steve Verreault, Gilles Montalescot, Josep Rodés-Cabau\",\"doi\":\"10.4244/EIJ-D-24-00156\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Limited data are available on transcatheter patent foramen ovale (PFO) closure outcomes in the elderly.</p><p><strong>Aims: </strong>Through this study, we aimed to determine the incidence and predictors of adverse events (recurrent cerebrovascular events [CVE] and atrial fibrillation [AF]) post-PFO closure in older patients with cryptogenic events.</p><p><strong>Methods: </strong>This multicentre international study included patients over 60 years undergoing PFO closure for cryptogenic thromboembolic events. A dedicated database compiled baseline, procedural, and follow-up data. Competing risk and adjusted outcome predictor analyses were conducted.</p><p><strong>Results: </strong>A total of 689 patients were included (median age 65 years, 41.2% female, mean Risk of Paradoxical Embolism [RoPE] score 4.5). The procedural success rate was 99.4%. After a median follow-up of 2 (interquartile range 1-5) years, 66 patients (9.6%) had died. CVE and stroke rates were 1.21 and 0.55 per 100 patient-years, respectively. Diabetes (hazard ratio [HR] 3.89, 95% confidence interval [CI]: 1.67-9.07; p=0.002) and atrial septal aneurysm (ASA; HR 5.25, 95% CI: 1.56-17.62; p=0.007) increased the CVE risk. New-onset AF occurred at a rate of 3.30 per 100 patient-years, with 51.3% within one month post-procedure. Older age (HR 1.05 per year, 95% CI: 1.00-1.09; p=0.023) and the absence of hypertension (HR 2.04, 95% CI: 1.19-3.57; p=0.010) were associated with an increased risk of AF.</p><p><strong>Conclusions: </strong>Older patients undergoing PFO closure had a relatively low rate of CVE and new-onset AF after a median follow-up of 2 years. The presence of diabetes, ASA, and a more advanced age determined an increased risk of adverse clinical events. These factors may be considered in the clinical decision-making process regarding PFO closure in this challenging population.</p>\",\"PeriodicalId\":54378,\"journal\":{\"name\":\"Eurointervention\",\"volume\":\"20 16\",\"pages\":\"1029-1038\"},\"PeriodicalIF\":7.6000,\"publicationDate\":\"2024-08-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11317834/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Eurointervention\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.4244/EIJ-D-24-00156\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Eurointervention","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4244/EIJ-D-24-00156","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Determinants of adverse outcomes following patent foramen ovale closure in elderly patients.
Background: Limited data are available on transcatheter patent foramen ovale (PFO) closure outcomes in the elderly.
Aims: Through this study, we aimed to determine the incidence and predictors of adverse events (recurrent cerebrovascular events [CVE] and atrial fibrillation [AF]) post-PFO closure in older patients with cryptogenic events.
Methods: This multicentre international study included patients over 60 years undergoing PFO closure for cryptogenic thromboembolic events. A dedicated database compiled baseline, procedural, and follow-up data. Competing risk and adjusted outcome predictor analyses were conducted.
Results: A total of 689 patients were included (median age 65 years, 41.2% female, mean Risk of Paradoxical Embolism [RoPE] score 4.5). The procedural success rate was 99.4%. After a median follow-up of 2 (interquartile range 1-5) years, 66 patients (9.6%) had died. CVE and stroke rates were 1.21 and 0.55 per 100 patient-years, respectively. Diabetes (hazard ratio [HR] 3.89, 95% confidence interval [CI]: 1.67-9.07; p=0.002) and atrial septal aneurysm (ASA; HR 5.25, 95% CI: 1.56-17.62; p=0.007) increased the CVE risk. New-onset AF occurred at a rate of 3.30 per 100 patient-years, with 51.3% within one month post-procedure. Older age (HR 1.05 per year, 95% CI: 1.00-1.09; p=0.023) and the absence of hypertension (HR 2.04, 95% CI: 1.19-3.57; p=0.010) were associated with an increased risk of AF.
Conclusions: Older patients undergoing PFO closure had a relatively low rate of CVE and new-onset AF after a median follow-up of 2 years. The presence of diabetes, ASA, and a more advanced age determined an increased risk of adverse clinical events. These factors may be considered in the clinical decision-making process regarding PFO closure in this challenging population.
期刊介绍：
EuroIntervention Journal is an international, English language, peer-reviewed journal whose aim is to create a community of high quality research and education in the field of percutaneous and surgical cardiovascular interventions.
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