Karagianni Alexia, Mandalenakis Zacharias, Papadopoulos Savvas, Dellborg Mikael, Eriksson Peter
Center for Adults with Congenital Heart Disease (ACHD), Sahlgrenska University Hospital/Östra, Sweden; Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, Gothenburg University, Sweden.
Department of Business Administration, School of Business, Economics and Law, University of Gothenburg, Sweden.
Int J Cardiol Congenit Heart Dis. 2023 Jan 5;11:100438. doi: 10.1016/j.ijcchd.2022.100438. eCollection 2023 Mar.
According to the current guidelines, evidence of the effects of transcatheter closure in patients aged ≥60 years with an atrial shunt and cryptogenic stroke is still limited.
Using Swedish health registries, patients aged ≥60 years who had previously developed a cryptogenic cerebrovascular event and undergone transcatheter closure were identified. Patients with atrial fibrillation were excluded, and the remaining patients were propensity score-matched with patients of the same age and risk profile who had only undergone medical treatment and with controls from the general population. They were then followed up until 2017 (mean period of 7.1 ± 3.9 years).
In total, 100 patients of the intervention group were matched with 100 patients of the medical treatment group and with 100 controls and followed up. The hazard ratio for a recurrent ischemic stroke in the intervention group compared with the medical treatment group was 0.8 (95% confidence interval, 0.3-2.1), and that compared with the controls was 2.3 (95% confidence interval, 0.6-8.9). Atrial fibrillation occurred at the same rate in the two treatment groups (odds ratio, 0.8; 95% confidence interval, 0.4-1.7). However, patients in the intervention group developed vascular disease at a lower rate (odds ratio, 0.5; 95% confidence interval, 0.25-0.85).
Patients aged ≥60 years with cryptogenic stroke may undergo transcatheter closure of an atrial shunt after thorough screening for other potential causes of stroke. The incidence of vascular disease seems to be mitigated in these patients relative to medically treated patients.
根据当前指南，对于≥60岁患有心房分流和隐源性卒中的患者，经导管封堵术效果的证据仍然有限。
利用瑞典健康登记系统，识别出≥60岁既往发生过隐源性脑血管事件并接受经导管封堵术的患者。排除心房颤动患者，其余患者根据倾向评分与年龄和风险特征相同、仅接受药物治疗的患者以及来自普通人群的对照组进行匹配。然后对他们进行随访至2017年（平均随访期7.1±3.9年）。
干预组共100例患者与药物治疗组100例患者以及100名对照组进行匹配并随访。干预组与药物治疗组相比，复发性缺血性卒中的风险比为0.8（95%置信区间，0.3 - 2.1），与对照组相比为2.3（95%置信区间，0.6 - 8.9）。两个治疗组心房颤动的发生率相同（比值比，0.8；95%置信区间，0.4 - 1.7）。然而，干预组患者发生血管疾病的比例较低（比值比，0.5；95%置信区间，0.25 - 0.85）。
≥60岁的隐源性卒中患者在对其他潜在卒中病因进行全面筛查后，可接受心房分流的经导管封堵术。相对于接受药物治疗的患者，这些患者血管疾病的发生率似乎有所降低。
