Lee Pil Hyung, Kim Jung-Sun, Song Jae-Kwan, Kwon Sun U, Kim Bum Joon, Lee Ji Sung, Sun Byung Joo, Woo Jong Shin, Ann Soe Hee, Suh Jung-Won, Kim Jun Yup, Lee Kyusup, Lee Sang Yeub, Heo Ran, Jeong Soo, Jang Jeong Yoon, Bae Jang-Whan, Kim Young Dae, Heo Sung Hyuk, Kim Jong S
Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
J Stroke. 2024 May;26(2):242-251. doi: 10.5853/jos.2023.03265. Epub 2024 May 30.
In young patients (aged 18-60 years) with patent foramen ovale (PFO)-associated stroke, percutaneous closure has been found to be useful for preventing recurrent ischemic stroke or transient ischemic attack (TIA). However, it remains unknown whether PFO closure is also beneficial in older patients.
Patients aged ≥60 years who had a cryptogenic stroke and PFO from ten hospitals in South Korea were included. The effect of PFO closure plus medical therapy over medical therapy alone was assessed by a propensity-score matching method in the overall cohort and in those with a high-risk PFO, characterized by the presence of an atrial septal aneurysm or a large shunt.
Out of the 437 patients (mean age, 68.1), 303 (69%) had a high-risk PFO and 161 (37%) patients underwent PFO closure. Over a median follow-up of 3.9 years, recurrent ischemic stroke or TIA developed in 64 (14.6%) patients. In the propensity score-matched cohort of the overall patients (130 pairs), PFO closure was associated with a significantly lower risk of a composite of ischemic stroke or TIA (hazard ratio [HR]: 0.45; 95% confidence interval [CI]: 0.24-0.84; P=0.012), but not for ischemic stroke. In a subgroup analysis of confined to the high-risk PFO patients (116 pairs), PFO closure was associated with significantly lower risks of both the composite of ischemic stroke or TIA (HR: 0.40; 95% CI: 0.21-0.77; P=0.006) and ischemic stroke (HR: 0.47; 95% CI: 0.23-0.95; P=0.035).
Elderly patients with cryptogenic stroke and PFO have a high recurrence rate of ischemic stroke or TIA, which may be significantly reduced by device closure.
在患有卵圆孔未闭（PFO）相关卒中的年轻患者（18 - 60岁）中，经皮封堵术已被证实对预防复发性缺血性卒中或短暂性脑缺血发作（TIA）有效。然而，PFO封堵术在老年患者中是否有益仍不明确。
纳入韩国十家医院年龄≥60岁、患有隐源性卒中和PFO的患者。通过倾向评分匹配法评估PFO封堵术联合药物治疗与单纯药物治疗相比在整个队列以及伴有高危PFO（以存在房间隔瘤或大量分流为特征）患者中的效果。
在437例患者（平均年龄68.1岁）中，303例（69%）有高危PFO，161例（37%）患者接受了PFO封堵术。在中位随访3.9年期间，64例（14.6%）患者发生了复发性缺血性卒中或TIA。在总体患者的倾向评分匹配队列（130对）中，PFO封堵术与缺血性卒中或TIA复合事件的风险显著降低相关（风险比[HR]：0.45；95%置信区间[CI]：0.24 - 0.84；P = 0.012），但与缺血性卒中无关。在仅限于高危PFO患者的亚组分析（116对）中，PFO封堵术与缺血性卒中或TIA复合事件（HR：0.40；95%CI：0.21 - 0.77；P = 0.006）以及缺血性卒中（HR：0.47；95%CI：0.23 - 0.95；P = 0.035）的风险显著降低相关。
患有隐源性卒中和PFO的老年患者缺血性卒中或TIA的复发率较高，而通过器械封堵术可能会显著降低该复发率。
