Transcatheter closure of PFO safe in older patients above 60 years, Circualtion study says
Canada: Transcatheter closure is safe and is associated with a relatively low risk of recurrent ischemic events in patients older than 60 years with a presumed patent foramen ovale (PFO)-related stroke, researchers report in a study published in Circulation: Cardiovascular Interventions. However, the researchers noticed a higher risk of recurrent cerebrovascular events in older patients versus their younger counterparts.
The main randomized trials investigating the patent foramen ovale (PFO) closure after a presumed PFO-associated stroke excluded elderly patients aged more than 60 years. Therefore, Alberto Alperi, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada, and colleagues aimed to evaluate the early- and long-term clinical outcomes of transcatheter PFO closure in older (>60 years) patients with a cryptogenic ischemic event in a multicenter study.
The study included consecutive patients older than 60 years who had a PFO closure following a presumed PFO-related ischemic event. Patients ≤60 years old (mean age, 44±10 years) were included in the control group. The occurrence of stroke, transient ischemic attack, or peripheral embolism over the follow-up period was the primary endpoint. New-onset atrial fibrillation was a secondary endpoint. The study included a total of 388 and 883 patients >60 and ≤60 years old were included, respectively.
The study led to the following findings:
- In both groups, the procedural success rate was high (99.9%), and procedural-related complications were low (<2%).
- After a median follow-up of 3 years, older patients exhibited an incidence of stroke/transient ischemic attack/peripheral embolism of 1.6 events per 100 patient-years (stroke: 0.6 events per 100 patient-years), lower than that expected according to the risk of paradoxical embolism score (observed-to-expected ratio, 0.31).
- The event rate in older patients was higher than that observed in their younger counterparts (incidence rate ratio, 4.7).
- De novo atrial fibrillation after the procedure was more frequent in older patients (2.66 per 100 patient-years versus 0.49 per 100 patient-years).
The authors conclude, "PFO closure was safe and associated with a relatively low incidence of recurrent ischemic events after a median follow-up of 3 years in patients older than 60 years with a presumed PFO-related ischemic event versus historical cohorts of patients who did not undergo PFO closure."
"A higher risk of recurrent cerebrovascular events however was observed in older patients compared to their younger counterparts," they wrote. "In this population, randomized trials are warranted."
Reference:
Alperi A, Guedeney P, Horlick E, Nombela-Franco L, Freixa X, Pascual I, Mesnier J, Houde C, Abrahamyan L, Montalescot G, Rodés-Cabau J. Transcatheter Closure of Patent Foramen Ovale in Older Patients With Cryptogenic Thromboembolic Events. Circ Cardiovasc Interv. 2022 Jun 23:101161CIRCINTERVENTIONS121011652. doi: 10.1161/CIRCINTERVENTIONS.121.011652. Epub ahead of print. PMID: 35735021.
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