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Vol. 73. Issue 3.
Pages 219-224 (March 2020)
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Vol. 73. Issue 3.
Pages 219-224 (March 2020)
Original article
DOI: 10.1016/j.rec.2019.07.003
Transcatheter closure of patent foramen ovale in patients older than 60 years of age with cryptogenic embolism
Cierre percutáneo del foramen oval permeable en pacientes mayores de 60 años con ictus criptogénico
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Jérôme Wintzer-Wehekinda, Alberto Alperia, Christine Houdeb, Jean-Marc Côtéb, David del Vala, Mélanie Côtéa, Josep Rodés-Cabaua,b,
Corresponding author
josep.rodes@criucpq.ulaval.ca

Corresponding author: Quebec Heart & Lung Institute, Laval University, 2725 Chemin Ste-Foy, G1V 4GS, Quebec City, Quebec, Canada.
a Quebec Heart and Lung Institute, Laval University, Quebec, Canada
b Centre Hospitalier Universitaire de Quebec, Quebec, Canada
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Table 1. Baseline clinical characteristics according to age (> 60 years vs ≤ 60 years)
Table 2. Procedural characteristics and in-hospital outcomes according to patients’ age
Table 3. Long-term clinical outcomes following patent foramen ovale closure, according to patients’ age
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Abstract
Introduction and objectives

Randomized trials have shown the efficacy of transcatheter closure of patent foramen ovale (PFO) in patients aged ≤ 60 years with cryptogenic embolism. We aimed to assess the long-term safety and efficacy of PFO closure in patients aged> 60 years.

Methods

Of 475 consecutive patients with cryptogenic embolism who underwent PFO closure, 90 older patients aged> 60 years (mean, 66±5 years) were compared with 385 younger patients aged ≤ 60 years (mean, 44±10 years).

Results

Older patients had a higher prevalence of cardiovascular risk factors (CVRF) (hypertension, dyslipidemia, diabetes; P <.01 for all vs younger patients). There were no differences in periprocedural complications between the 2 groups. During a median follow-up of 8 (4-12) years, there were a total of 17 deaths, all from noncardiovascular causes (7.8% and 2.6% in the older and younger patient groups, respectively; HR, 4.12; 95%CI, 1.56-10.89). Four patients had a recurrent stroke (2.2% and 0.5% in the older and younger patient groups, respectively; HR, 5.08; 95%CI, 0.71-36.2), and 12 patients had a transient ischemic attack (TIA) (3.3% and 2.3% in the older and younger patient groups, respectively; HR, 1.71; 95%CI, 0.46-6.39). There was a trend toward a higher rate of the composite of stroke/TIA in older patients (5.5% vs 2.6%; HR, 2.62; 95%CI, 0.89-7.75; P=.081), which did not persist after adjustment for CVRF (HR, 1.97; 95%CI, 0.59-6.56; P=.269).

Conclusions

In older patients with cryptogenic embolism, PFO closure was safe and associated with a low rate of ischemic events at long-term. However, older patients exhibited a tendency toward a higher incidence of recurrent stroke/TIA compared with younger patients, likely related to a higher burden of CVRF.

Keywords:
Patent foramen ovale
Closure
Stroke
Transient ischemic attack
Older
Abbreviations:
PFO
RoPE
TEE
TIA
TTE
Resumen
Introducción y objetivos

Estudios aleatorizados han mostrado la eficacia del cierre percutáneo del foramen oval permeable (FOP) en pacientes de edad ≤ 60 años con ictus criptogénico. El objetivo de este estudio es determinar la seguridad y la eficacia a largo plazo del cierre percutáneo del FOP en pacientes mayores de 60 años con ictus criptogénico.

Métodos

De 475 pacientes consecutivos con ictus criptogénico que se sometieron al cierre del FOP, 90 eran mayores de 60 años (media, 66±5 años) y se los comparó con los 385 del grupo de edad ≤ 60 años (media, 44±10 años).

Resultados

Los pacientes mayores de 60 años tuvieron mayor prevalencia de factores de riesgo cardiovascular (FRCV) (hipertensión, dislipemia y diabetes; p <0,01). No hubo diferencias en cuanto a complicaciones periprocedimiento. El seguimiento medio fue de 8 (4-12) años y hubo 17 muertes, todas de causa no cardiovascular (el 7,8% de los mayores de 60 años y el 2,6% de los de edad ≤ 60 años; HR=4,12; IC95%, 1,56-10,89). Tuvieron un ictus recurrente 4 pacientes (el 2,2% de los mayores de 60 años frente al 0,5% de los de edad ≤ 60 años; HR=5,08; IC95%, 0,71-36,2), y un accidente isquémico transitorio (AIT) 12 pacientes (el 3,3 frente al 2,3%; HR=1,71; IC95%, 0,46-6,39). Hubo tendencia a una mayor incidencia de ictus/AIT en los mayores de 60 años (el 5,5 frente al 2,6%; HR=2,62; IC95%, 0,89-7,75; p=0,081), que no persistió tras ajustar por FRCV (HR=1,97; IC95%, 0,59-6,56; p=0,269).

Conclusiones

El cierre percutáneo del FOP en pacientes mayores de 60 años con ictus criptogénico resultó seguro y se asoció con una baja incidencia de eventos isquémicos a largo plazo. Sin embargo, en los pacientes mayores de 60 años se observó una tendencia a mayor incidencia de ictus/AIT probablemente relacionada con mayor prevalencia de FRCV.

Palabras clave:
Foramen oval permeable
Cierre
Ictus
Accidente isquémico transitorio
Edad avanzada

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