Assessment of patent foramen ovale closure in elderly patients with cryptogenic transient ischemic attack or stroke: Efficacy, safety, and potential age-related benefit.

INTRODUCTION

The efficacy and safety of patent foramen ovale closure (PFOC) in cryptogenic stroke (CS) patients aged ⩾ 60 remain controversial. This study evaluates the efficacy and safety of PFOC in elderly (aged ⩾ 60) versus non-elderly (aged < 60) patients and examines potential age-related benefit.

PATIENTS AND METHODS

A hospital-based cohort study (January 2013-June 2023) compared the efficacy and safety between PFOC and non-PFOC groups in patient with CS or cryptogenic TIA. The primary efficacy outcome was recurrent ischemic stroke, and safety outcomes included procedure-related adverse events and periprocedural atrial fibrillation (AF). Subgroup analyses, including various age ranges, were performed for the elderly group.

RESULTS

Among 239 patients (mean age 57.2 years), 120 were elderly. During a mean follow-up of 3.1 years, the PFOC group had significantly fewer recurrent ischemic stroke than the non-PFOC group (adjusted hazard ratio (AHR): 0.10, 95% CI: 0.03-0.29,  = 0.001). The risk reduction was similar in elderly (AHR: 0.11,  = 0.004) and non-elderly (AHR: 0.10,  = 0.005) patients ( for interaction = 0.337). Safety outcomes were comparable across age groups, including younger elderly (60-70) and older elderly (⩾70). No life-threatening complications occurred; one patient required additional intervention. Subgroup analysis indicated significant risk reduction for patients aged ⩾ 65 (AHR: 0.01,  = 0.012) but not for those aged 60-65 (AHR: 0.24,  = 0.071).

DISCUSSION AND CONCLUSION

PFO closure is safe and effective in elderly patients with CS. Advanced age should not be a contraindication for PFOC, as older patients may potentially derive more significant benefits from the procedure.