Residual Shunt After Patent Foramen Ovale Closure and Long-Term Stroke Recurrence : A Prospective Cohort Study
BACKGROUND: Residual shunt is observed in up to 25% of patients after patent foramen ovale (PFO) closure, but its long-term influence on stroke recurrence currently is unknown.
OBJECTIVE: To investigate the association of residual shunt after PFO closure with the incidence of recurrent stroke and transient ischemic attack (TIA).
DESIGN: Prospective cohort study comparing stroke or TIA recurrence in patients with and without residual shunt after PFO closure.
SETTING: Single hospital center.
PARTICIPANTS: 1078 consecutive patients (mean age, 49.3 years) with PFO-attributable cryptogenic stroke who were undergoing percutaneous PFO closure were followed for up to 11 years.
MEASUREMENTS: Residual shunt was evaluated by transthoracic echocardiography with saline contrast. Primary outcome was a composite of the first recurrent ischemic stroke or TIA after PFO closure.
RESULTS: Compared with complete closure, the presence of residual shunt after PFO closure was associated with an increased incidence of recurrent stroke or TIA: 2.32 versus 0.75 events per 100 patient-years (hazard ratio [HR], 3.05 [95% CI, 1.65 to 5.62]; P < 0.001). This result remained robust after adjustment for important covariates, namely age; study period; device; presence of atrial septal aneurysm, hypertension, hyperlipidemia, diabetes, hypercoagulability, or hypermobile septum; and medication use (HR, 3.01 [CI, 1.59 to 5.69]; P < 0.001). Further stratification based on shunt size revealed that moderate or large residual shunts were associated with a higher risk for stroke or TIA recurrence (HR, 4.50 [CI, 2.20 to 9.20]; P < 0.001); the result for small residual shunts was indeterminate (HR, 2.02 [CI, 0.87 to 4.69]; P = 0.102).
LIMITATION: Nonrandomized study with potential unmeasured confounding.
CONCLUSION: Among patients undergoing PFO closure to prevent future stroke, the presence of residual shunt, particularly a moderate or large residual shunt, was associated with an increased risk for stroke or TIA recurrence.
PRIMARY FUNDING SOURCE: National Institutes of Health.
| Errataetall: |
CommentIn: Ann Intern Med. 2020 Dec 1;173(11):946-947. - PMID 33253613 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:172 |
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| Enthalten in: |
Annals of internal medicine - 172(2020), 11 vom: 02. Juni, Seite 717-725 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Deng, Wenjun [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 16.11.2020 Date Revised 20.03.2023 published: Print-Electronic CommentIn: Ann Intern Med. 2020 Dec 1;173(11):946-947. - PMID 33253613 Citation Status MEDLINE |
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| doi: |
10.7326/M19-3583 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM310046629 |
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| 100 | 1 | |a Deng, Wenjun |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Residual Shunt After Patent Foramen Ovale Closure and Long-Term Stroke Recurrence |b A Prospective Cohort Study |
| 264 | 1 | |c 2020 | |
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| 500 | |a Date Completed 16.11.2020 | ||
| 500 | |a Date Revised 20.03.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Ann Intern Med. 2020 Dec 1;173(11):946-947. - PMID 33253613 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Residual shunt is observed in up to 25% of patients after patent foramen ovale (PFO) closure, but its long-term influence on stroke recurrence currently is unknown | ||
| 520 | |a OBJECTIVE: To investigate the association of residual shunt after PFO closure with the incidence of recurrent stroke and transient ischemic attack (TIA) | ||
| 520 | |a DESIGN: Prospective cohort study comparing stroke or TIA recurrence in patients with and without residual shunt after PFO closure | ||
| 520 | |a SETTING: Single hospital center | ||
| 520 | |a PARTICIPANTS: 1078 consecutive patients (mean age, 49.3 years) with PFO-attributable cryptogenic stroke who were undergoing percutaneous PFO closure were followed for up to 11 years | ||
| 520 | |a MEASUREMENTS: Residual shunt was evaluated by transthoracic echocardiography with saline contrast. Primary outcome was a composite of the first recurrent ischemic stroke or TIA after PFO closure | ||
| 520 | |a RESULTS: Compared with complete closure, the presence of residual shunt after PFO closure was associated with an increased incidence of recurrent stroke or TIA: 2.32 versus 0.75 events per 100 patient-years (hazard ratio [HR], 3.05 [95% CI, 1.65 to 5.62]; P < 0.001). This result remained robust after adjustment for important covariates, namely age; study period; device; presence of atrial septal aneurysm, hypertension, hyperlipidemia, diabetes, hypercoagulability, or hypermobile septum; and medication use (HR, 3.01 [CI, 1.59 to 5.69]; P < 0.001). Further stratification based on shunt size revealed that moderate or large residual shunts were associated with a higher risk for stroke or TIA recurrence (HR, 4.50 [CI, 2.20 to 9.20]; P < 0.001); the result for small residual shunts was indeterminate (HR, 2.02 [CI, 0.87 to 4.69]; P = 0.102) | ||
| 520 | |a LIMITATION: Nonrandomized study with potential unmeasured confounding | ||
| 520 | |a CONCLUSION: Among patients undergoing PFO closure to prevent future stroke, the presence of residual shunt, particularly a moderate or large residual shunt, was associated with an increased risk for stroke or TIA recurrence | ||
| 520 | |a PRIMARY FUNDING SOURCE: National Institutes of Health | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Aneurysms | |
| 650 | 4 | |a Echocardiography | |
| 650 | 4 | |a Factor analysis | |
| 650 | 4 | |a Hyperlipidemia | |
| 650 | 4 | |a Hypertension | |
| 650 | 4 | |a Ischemic stroke | |
| 650 | 4 | |a Longitudinal studies | |
| 650 | 4 | |a Medical risk factors | |
| 650 | 4 | |a Stroke | |
| 650 | 4 | |a Transient ischemic attacks | |
| 700 | 1 | |a Yin, Shanye |e verfasserin |4 aut | |
| 700 | 1 | |a McMullin, David |e verfasserin |4 aut | |
| 700 | 1 | |a Inglessis-Azuaje, Ignacio |e verfasserin |4 aut | |
| 700 | 1 | |a Elmariah, Sammy |e verfasserin |4 aut | |
| 700 | 1 | |a Hung, Judy |e verfasserin |4 aut | |
| 700 | 1 | |a Lo, Eng H |e verfasserin |4 aut | |
| 700 | 1 | |a Palacios, Igor F |e verfasserin |4 aut | |
| 700 | 1 | |a Buonanno, Ferdinando S |e verfasserin |4 aut | |
| 700 | 1 | |a Ning, MingMing |e verfasserin |4 aut | |
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