Abstract 15497: Correlates of Treatment Strategy and Predictors of Outcome in Patients with Cryptogenic Stroke and Patent Foramen Ovale
Background and Aim: There is still controversy regarding the benefit of percutaneous closure of patent foramen ovale (PFO) among patients with cryptogenic stroke (CS). We aimed to evaluate factors influencing the treatment choice and predictors of adverse events in patients with CS or transient ischemic attack (TIA) and PFO.
Methods: Of 419 consecutive patients with CS or TIA and PFO 263 underwent percutaneous PFO closure whereas 156 were medically treated. Multivariable logistic regression models were developed to evaluate factors influencing the treatment strategy and predictors of outcome, a composite of stroke, TIA or all-cause mortality.
Results: Patients with large interatrial right-to-left (R-L) shunt were more likely treated with percutaneous closure (adjusted odds ratio OR= 4.79, 95% confidence intervals [2.73-8.42]; p<0.0001) whereas those with multiple cerebrovascular accident (CVA) risk factors were more likely treated medically (OR= 0.15 [0.03-0.60]; p= 0.023). After 10 years of follow up there was no difference in the cumulative incidence of the outcome between the groups (Fig.1). Age >55 years (OR= 2.70 [1.05-6.88]; p=0.04), previous CVAs (OR= 2.49 [1.03-6.02]; p= 0.02) and atrial septal aneurism (ASA, OR= 2.64 [1.09-6.39]; p= 0.02) but not percutaneous closure of PFO (OR= 1.10 [0.44-2.74]; p= 0.81) were independent predictors of outcome (Fig.2).
Conclusions: Amongst patients with CS and PFO the presence of large interatrial R-L shunt and multiple CVA risk factors influenced the treatment choice. Older age, multiple previous CVA and ASA but not PFO closure, independently predicted the composite outcome of CS, TIA or all-cause mortality.
- © 2012 by American Heart Association, Inc.