Patent foramen ovale closure versus drug therapy in patients over 60 years and a follow‐up of 5 years

• Published in: Clinical cardiology (Mahwah, N.J.) N.J.), 2024-02, Vol.47 (3), p.e24251-n/a
• Main Authors: Eichelmann, Angelika, Kubini, Ralf, Nachoski, Dejan, Kosinski, Christoph, Becker, Michael, Aljalloud, Ali
• Format: Article
• Language: English
• Subjects: Age; Aneurysms; Aspirin; Atrial Fibrillation; Blood clots; Cerebral Infarction; Clinical Trial; cryptogenic stroke; Disease prevention; elder patients; Embolisms; Family physicians; Follow-Up Studies; Foramen Ovale, Patent - complications; Foramen Ovale, Patent - diagnostic imaging; Foramen Ovale, Patent - therapy; Health care; Humans; Ischemia; Magnetic resonance imaging; Medical treatment; Middle Aged; patent foramen ovale; Patients; PFO and atrial fibrillation; PFO closure; Risk factors; Stroke; Stroke - etiology; Stroke - prevention & control; Thromboembolism
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.24251

Background The advantages of patent foramen ovale (PFO) closure as protection from a recurrence of stroke remains controversial compared to drug therapy, especially in patients over 60 years. Hypothesis The aim of the study is to compare recurrence of stroke in patients over 60 years old with PFO closure versus drug therapy alone. Methods We included 342 patients over 60 years who suffered a crytopgenic stroke, and were also accepted for a PFO closure. 199 patients refused a PFO closure and were treated with medical therapy alone, whereas 143 patients underwent a PFO closure procedure. Results The mean follow up time was 5.5 ± 1.5 years. All patients in Group B showed persistent shunt in the follow‐up period (n = 199, 100%). In Group A, seven patients were diagnosed with residual shunt during echocardiography examination (5%). A new onset of atrial fibrillation occurred in seven patients in Group A (5%) and six patients in Group B (3%), p = .117. Recurrent stroke occurred in 3 patients in Group A (2%) and 11 patients in Group B (6%), p = .021. One patient died of unknown reason (1%) and two patients were lost due to neurological death (1%) in Group B, whereas no patients in Group A died during the follow‐up period. Conclusion Our results show that strict exclusion of patients over 60 years from PFO closure should be reconsidered. As life expectancies are increasing, patients should be considered for same treatment as younger patients, since the outcomes are improved compared to patients treated with medical therapy alone. Results of this follow‐up‐study show that strict exclusion of patients over 60 years from patent foramen ovale closure should be reconsidered. As life expectancies are increasing, patients should be considered for same treatment as younger patients, since the outcomes are improved compared to patients treated with medical therapy alone.