Novel Scoring System to Identify Which Patients Benefit From PFO Device Closure
Patent foramen ovale (PFO) - associated strokes comprise approximately 10% of ischemic strokes in adults aged 18 to 60 years. In a recent study, researchers developed a novel classification system that helps to differentiate which patients with ischemic stroke of the unknown origin might benefit from patent foramen ovale closure. The study findings were published in the JAMA on December 14, 2021.
While PFO device closure decreases stroke recurrence risk overall, the best treatment for any individual is often unclear. Therefore, Dr David M. Kent and his team conducted a study to evaluate heterogeneity of treatment effect of PFO closure on stroke recurrence based on previously developed scoring systems.
The researchers pooled individual patient data from the Systematic, Collaborative, PFO Closure Evaluation (SCOPE) consortium, which analyzed 3,740 patients data from six randomized trials comparing PFO closure plus medical therapy to medical therapy alone for recurrent stroke prevention.
The researchers compared the effect of PFO closure plus medical therapy and medical therapy alone. In subgroup analyses, they used the Risk of Paradoxical Embolism (RoPE) Score (a 10-point scoring system in which higher scores reflect younger age and the absence of vascular risk factors) and the PFO-Associated Stroke Causal Likelihood (PASCAL) Classification System, which combines the RoPE Score with high-risk PFO features (either an atrial septal aneurysm or a large-sized shunt) to classify patients into 3 categories of causal relatedness: unlikely, possible, and probable. The major outcome assessed was the incidence of ischemic stroke.
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