Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
JACC Cardiovasc Interv. 2014 Nov;7(11):1221-6. doi: 10.1016/j.jcin.2014.04.025. Epub 2014 Oct 15.
This study investigated whether patients with patent foramen ovale (PFO) have an increased risk of stroke due to permanent pacemaker (PPM)/implantable cardioverter-defibrillator (ICD) implantation.
Data are lacking on the risk of stroke in patients with PFO and implantable intracardiac devices, either a PPM or an ICD. We investigated whether patients with PFO have increased risk of stroke due to PPM/ICD implantation.
Between 2001 and 2008, 2,921 consecutive patients with PFO (67.5 ± 16.4 years of age, 52.2% male) were identified from our echocardiography database. These patients were divided into a device group (patients had PPM/ICD implantation for any reason after receiving a diagnosis of PFO) and a no device group (patients did not have PPM or ICD implantation). Patients who had PFO closure during follow-up were excluded. Both groups were matched for baseline characteristics and medications. The incidence of ischemic stroke was assessed in each group after propensity score matching (case:control ratio of 1:1 yielding 231 pairs). All patients completed at least 4 years of follow-up until May 2012.
There were 2,690 patients in the n device group (67.3 ± 16.4 years of age, 51.6% male) and 231 patients in the device group (75.4 ± 14.6 years of age, 59.3% male). Six patients (2.6%) in the no device group and 6 (2.6%) in the device group had a stroke during the follow-up period. No difference in the rate of stroke, transient ischemic stroke, or stroke/transient ischemic stroke was observed between the 2 groups.
The risk of stroke in patients with PFO and an implantable intracardiac device is similar to those without an intracardiac device. In patients with PFO, without a history of stroke, device implantation might not be considered a risk factor for future stroke occurrence.
本研究旨在探讨卵圆孔未闭（PFO）患者因植入永久性心脏起搏器（PPM）/植入式心脏复律除颤器（ICD）而发生卒中的风险是否增加。
目前尚缺乏 PFO 合并植入性心内装置（PPM 或 ICD）患者发生卒中风险的数据。我们调查了 PFO 患者因植入 PPM/ICD 而发生卒中的风险是否增加。
2001 年至 2008 年，我们从超声心动图数据库中确定了 2921 例连续 PFO 患者（67.5±16.4 岁，52.2%为男性）。这些患者被分为器械组（因 PFO 诊断后任何原因植入 PPM/ICD）和无器械组（未植入 PPM 或 ICD）。在随访过程中接受 PFO 封堵术的患者被排除在外。两组患者均按基线特征和药物进行匹配。在倾向评分匹配后（每组病例：对照为 1:1，共 231 对）评估每组患者缺血性卒中的发生率。所有患者至少随访 4 年，随访时间截止至 2012 年 5 月。
无器械组有 2690 例患者（67.3±16.4 岁，51.6%为男性），器械组有 231 例患者（75.4±14.6 岁，59.3%为男性）。无器械组有 6 例（2.6%）患者和器械组有 6 例（2.6%）患者在随访期间发生卒中。两组患者的卒中、短暂性脑缺血发作或卒中/短暂性脑缺血发作发生率无差异。
PFO 合并植入性心内装置患者的卒中风险与无植入性心内装置患者相似。对于无卒中病史的 PFO 患者，器械植入可能不应被视为未来卒中发生的危险因素。
