Wintzer-Wehekind Jérôme, Alperi Alberto, Houde Christine, Côté Jean-Marc, Del Val David, Côté Mélanie, Rodés-Cabau Josep
Quebec Heart and Lung Institute, Laval University, Quebec, Canada.
Centre Hospitalier Universitaire de Quebec, Quebec, Canada.
Rev Esp Cardiol (Engl Ed). 2020 Mar;73(3):219-224. doi: 10.1016/j.rec.2019.07.003. Epub 2019 Oct 1.
Randomized trials have shown the efficacy of transcatheter closure of patent foramen ovale (PFO) in patients aged ≤ 60 years with cryptogenic embolism. We aimed to assess the long-term safety and efficacy of PFO closure in patients aged> 60 years.
Of 475 consecutive patients with cryptogenic embolism who underwent PFO closure, 90 older patients aged> 60 years (mean, 66±5 years) were compared with 385 younger patients aged ≤ 60 years (mean, 44±10 years).
Older patients had a higher prevalence of cardiovascular risk factors (CVRF) (hypertension, dyslipidemia, diabetes; P <.01 for all vs younger patients). There were no differences in periprocedural complications between the 2 groups. During a median follow-up of 8 (4-12) years, there were a total of 17 deaths, all from noncardiovascular causes (7.8% and 2.6% in the older and younger patient groups, respectively; HR, 4.12; 95%CI, 1.56-10.89). Four patients had a recurrent stroke (2.2% and 0.5% in the older and younger patient groups, respectively; HR, 5.08; 95%CI, 0.71-36.2), and 12 patients had a transient ischemic attack (TIA) (3.3% and 2.3% in the older and younger patient groups, respectively; HR, 1.71; 95%CI, 0.46-6.39). There was a trend toward a higher rate of the composite of stroke/TIA in older patients (5.5% vs 2.6%; HR, 2.62; 95%CI, 0.89-7.75; P=.081), which did not persist after adjustment for CVRF (HR, 1.97; 95%CI, 0.59-6.56; P=.269).
In older patients with cryptogenic embolism, PFO closure was safe and associated with a low rate of ischemic events at long-term. However, older patients exhibited a tendency toward a higher incidence of recurrent stroke/TIA compared with younger patients, likely related to a higher burden of CVRF.
随机试验已表明，经导管闭合卵圆孔未闭（PFO）对年龄≤60岁的不明原因栓塞患者有效。我们旨在评估年龄>60岁患者闭合PFO的长期安全性和有效性。
在475例连续接受PFO闭合术的不明原因栓塞患者中，将90例年龄>60岁的老年患者（平均66±5岁）与385例年龄≤60岁的年轻患者（平均44±10岁）进行比较。
老年患者心血管危险因素（CVRF）（高血压、血脂异常、糖尿病）的患病率更高（与年轻患者相比，所有因素P均<.01）。两组围手术期并发症无差异。在中位随访8（4 - 12）年期间，共有17例死亡，均为非心血管原因（老年和年轻患者组分别为7.8%和2.6%；HR，4.12；95%CI，1.56 - 10.89）。4例患者发生复发性卒中（老年和年轻患者组分别为2.2%和0.5%；HR，5.08；95%CI，0.71 - 36.2），12例患者发生短暂性脑缺血发作（TIA）（老年和年轻患者组分别为3.3%和2.3%；HR，1.71；95%CI，0.46 - 6.39）。老年患者卒中/TIA复合事件发生率有升高趋势（5.5%对2.6%；HR，2.62；95%CI，0.89 - 7.75；P = 0.081），在调整CVRF后该趋势未持续（HR，1.97；95%CI，0.59 - 6.56；P = 0.269）。
在不明原因栓塞的老年患者中，PFO闭合术是安全的，且长期缺血事件发生率较低。然而，与年轻患者相比，老年患者复发性卒中/TIA发生率有升高趋势，可能与CVRF负担较重有关。
