非老年和老年隐源性卒中患者卵圆孔未闭封堵术：一项基于医院的队列研究。
Patent foramen ovale closure in non-elderly and elderly patients with cryptogenic stroke: a hospital-based cohort study.
作者信息
Chen Po-Lin, Wang Chi-Sheng, Huang Jin-An, Fu Yun-Ching, Liao Nien-Chen, Hsu Chiann-Yi, Wu Yu-Hsuan
机构信息
Division of Neurology, Taichung Veterans General Hospital, Neurological Institute, Taichung, Taiwan.
School of Medicine, Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.
出版信息
Front Neurol. 2023 May 16;14:1190011. doi: 10.3389/fneur.2023.1190011. eCollection 2023.
INTRODUCTION
The efficacy of patent foramen ovale (PFO) closure in the elderly population is unclear. We aimed to investigate the efficacy and safety of PFO closure in non-elderly and elderly patients.
METHODS
Patients over 18 years of age with cryptogenic stroke (CS) or transient ischemic attack and PFO were prospectively enrolled and classified into two groups according to treatment: (1) closure of PFO (the PFOC group) and (2) medical treatment alone (the non-PFOC group). The primary outcome was a composite of recurrent cerebral ischemic events and all-cause mortality during the follow-up period. A modified Ranking Scale [mRS] at 180 days was recorded. The safety outcomes were procedure-related adverse events and periprocedural atrial fibrillation. The results between the PFOC and non-PFOC groups in non-elderly (<60 years) and elderly (≥60 years) patients were compared.
RESULTS
We enrolled 173 patients, 78 (45%) of whom were elderly. During a mean follow-up of 2.5 years, the incidence of primary outcome was significantly lower in the PFOC group (6.2% vs. 17.1%, hazard ratio[HR] = 0.35, 95% CI 0.13-0.97, = 0.043) in adjusted Cox regression analysis. Compared with the non-PFOC group, the PFOC group had a numerically lower risk of the primary outcome in both the elderly (HR 0.26, 95% CI 0.07-1.01, = 0.051) and the non-elderly (HR 0.61, 95% CI 0.11-3.27, = 0.574) groups. In addition, patients with PFO closure in the elderly group had a lower median mRS at 180 days ( = 0.002). The rate of safety outcome was similar between the non-elderly and elderly groups.
DISCUSSION
PFO closure was associated with a reduced risk of the primary outcome in patients with PFO and CS in our total cohort, which included non-elderly and elderly patients. Compared to those without PFO closure, elderly patients with PFO closure had a better functional outcome at 180 days. PFO closure might be considered in selected elderly patients with PFO.
引言
卵圆孔未闭（PFO）封堵术在老年人群中的疗效尚不清楚。我们旨在研究PFO封堵术在非老年和老年患者中的疗效及安全性。
方法
前瞻性纳入年龄在18岁以上、患有隐源性卒中（CS）或短暂性脑缺血发作且伴有PFO的患者，并根据治疗方法分为两组：（1）PFO封堵组（PFOC组）和（2）单纯药物治疗组（非PFOC组）。主要结局是随访期间复发性脑缺血事件和全因死亡率的复合指标。记录180天时的改良Rankin量表[mRS]。安全性结局是与手术相关的不良事件和围手术期房颤。比较了非老年（<60岁）和老年（≥60岁）患者中PFOC组和非PFOC组的结果。
结果
我们纳入了173例患者，其中78例（45%）为老年人。在平均2.5年的随访期间，经调整的Cox回归分析显示，PFOC组的主要结局发生率显著较低（6.2%对17.1%，风险比[HR]=0.35，95%置信区间0.13 - 0.97，P = 0.043）。与非PFOC组相比，PFOC组在老年组（HR 0.26，95%置信区间0.07 - 1.01，P = 0.051）和非老年组（HR 0.61，95%置信区间0.11 - 3.27，P = 0.574）中主要结局的风险在数值上均较低。此外，老年组中接受PFO封堵的患者在180天时的mRS中位数较低（P = 0.002）。非老年组和老年组的安全性结局发生率相似。
讨论
在我们纳入了非老年和老年患者的整个队列中，PFO封堵术与患有PFO和CS的患者主要结局风险降低相关。与未进行PFO封堵的患者相比，接受PFO封堵的老年患者在180天时功能结局更好。对于选定的患有PFO的老年患者，可考虑进行PFO封堵。
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