Patent foramen ovale closure in non-elderly and elderly patients with cryptogenic stroke: a hospital-based cohort study

Po-Lin Chen; Chi-Sheng Wang; Jin-An Huang; Yun-Ching Fu; Nien-Chen Liao; Chiann-Yi Hsu; Yu-Hsuan Wu

doi:10.3389/fneur.2023.1190011

Patent foramen ovale closure in non-elderly and elderly patients with cryptogenic stroke: a hospital-based cohort study

Front Neurol. 2023 May 16:14:1190011. doi: 10.3389/fneur.2023.1190011. eCollection 2023.

Authors

Po-Lin Chen^{1

2

3}, Chi-Sheng Wang^#¹, Jin-An Huang^{1

3

4}, Yun-Ching Fu^{5

6

7}, Nien-Chen Liao^{1

8}, Chiann-Yi Hsu⁹, Yu-Hsuan Wu^#¹

Affiliations

¹ Division of Neurology, Taichung Veterans General Hospital, Neurological Institute, Taichung, Taiwan.
² School of Medicine, Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
⁴ Department of Health Business Administration, Hungkuang University, Taichung, Taiwan.
⁵ Department of Pediatrics, Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan.
⁶ Department of Pediatrics, School of Medicine, National Chung Hsing University, Taichung, Taiwan.
⁷ Department of Pediatrics and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁸ Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
⁹ Biostatistics Task Force, Taichung Veterans General Hospital, Taichung, Taiwan.

^# Contributed equally.

Abstract

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, p = 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, p = 0.051) and the non-elderly (HR 0.61, 95% CI 0.11-3.27, p = 0.574) groups. In addition, patients with PFO closure in the elderly group had a lower median mRS at 180 days (p = 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.

Keywords: cryptogenic stroke; ischemic stroke; outcome; patent foramen ovale; patent foramen ovale closure.