Transcatheter closure of patent foramen ovale in patients older than 60 years of age with cryptogenic embolism

Jérôme Wintzer-Wehekind; Alberto Alperi; Christine Houde; Jean-Marc Côté; David Del Val; Mélanie Côté; Josep Rodés-Cabau

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

Rev Esp Cardiol (Engl Ed). 2020 Mar;73(3):219-224. doi: 10.1016/j.rec.2019.07.003. Epub 2019 Oct 1.

[Article in English, Spanish]

Authors

Jérôme Wintzer-Wehekind¹, Alberto Alperi¹, Christine Houde², Jean-Marc Côté², David Del Val¹, Mélanie Côté¹, Josep Rodés-Cabau³

Affiliations

¹ Quebec Heart and Lung Institute, Laval University, Quebec, Canada.
² Centre Hospitalier Universitaire de Quebec, Quebec, Canada.
³ Quebec Heart and Lung Institute, Laval University, Quebec, Canada; Centre Hospitalier Universitaire de Quebec, Quebec, Canada. Electronic address: [email protected].

PMID: 31585849
DOI: 10.1016/j.rec.2019.07.003

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: Accidente isquémico transitorio; Cierre; Closure; Edad avanzada; Foramen oval permeable; Ictus; Older; Patent foramen ovale; Stroke; Transient ischemic attack.

MeSH terms

Adult
Age Factors
Aged
Cause of Death
Diabetes Mellitus / epidemiology
Dyslipidemias / epidemiology
Embolism / complications*
Female
Foramen Ovale, Patent / complications
Foramen Ovale, Patent / mortality
Foramen Ovale, Patent / surgery*
Humans
Hypertension / epidemiology
Ischemic Attack, Transient / epidemiology*
Male
Middle Aged
Postoperative Complications / epidemiology
Prevalence
Recurrence
Risk Factors
Septal Occluder Device*
Stroke / epidemiology*