TY - JOUR
T1 - Determinants of adverse outcomes following patent foramen ovale closure in elderly patients
AU - Farjat-Pasos, Julio I
AU - Guedeney, Paul
AU - Horlick, Eric
AU - Abtan, Jeremie
AU - Nombela-Franco, Luis
AU - Hibbert, Benjamin
AU - Sondergaard, Lars
AU - Freixa, Xavier
AU - Masson, Jean-Bernard
AU - Cruz-González, Ignacio
AU - Estévez-Loureiro, Rodrigo
AU - Faroux, Laurent
AU - Shah, Ashish H
AU - Abrahamyan, Lusine
AU - Mesnier, Jules
AU - Jerónimo, Adrián
AU - Abdel-Razek, Omar
AU - Jørgensen, Troels Højsgaard
AU - Asmar, Mike Al
AU - Sitbon, Samuel
AU - Abalhassan, Mohammed
AU - Robichaud, Mathieu
AU - Houde, Christine
AU - Côté, Mélanie
AU - Chamorro, Angel
AU - Lanthier, Sylvain
AU - Verreault, Steve
AU - Montalescot, Gilles
AU - Rodés-Cabau, Josep
PY - 2024/8/19
Y1 - 2024/8/19
N2 - BACKGROUND: Limited data are available on transcatheter patent foramen ovale (PFO) closure outcomes in the elderly.AIMS: Through this study, we aimed to determine the incidence and predictors of adverse events (recurrent cerebrovascular events [CVE] and atrial fibrillation [AF]) post-PFO closure in older patients with cryptogenic events.METHODS: This multicentre international study included patients over 60 years undergoing PFO closure for cryptogenic thromboembolic events. A dedicated database compiled baseline, procedural, and follow-up data. Competing risk and adjusted outcome predictor analyses were conducted.RESULTS: A total of 689 patients were included (median age 65 years, 41.2% female, mean Risk of Paradoxical Embolism [RoPE] score 4.5). The procedural success rate was 99.4%. After a median follow-up of 2 (interquartile range 1-5) years, 66 patients (9.6%) had died. CVE and stroke rates were 1.21 and 0.55 per 100 patient-years, respectively. Diabetes (hazard ratio [HR] 3.89, 95% confidence interval [CI]: 1.67-9.07; p=0.002) and atrial septal aneurysm (ASA; HR 5.25, 95% CI: 1.56-17.62; p=0.007) increased the CVE risk. New-onset AF occurred at a rate of 3.30 per 100 patient-years, with 51.3% within one month post-procedure. Older age (HR 1.05 per year, 95% CI: 1.00-1.09; p=0.023) and the absence of hypertension (HR 2.04, 95% CI: 1.19-3.57; p=0.010) were associated with an increased risk of AF.CONCLUSIONS: Older patients undergoing PFO closure had a relatively low rate of CVE and new-onset AF after a median follow-up of 2 years. The presence of diabetes, ASA, and a more advanced age determined an increased risk of adverse clinical events. These factors may be considered in the clinical decision-making process regarding PFO closure in this challenging population.
AB - BACKGROUND: Limited data are available on transcatheter patent foramen ovale (PFO) closure outcomes in the elderly.AIMS: Through this study, we aimed to determine the incidence and predictors of adverse events (recurrent cerebrovascular events [CVE] and atrial fibrillation [AF]) post-PFO closure in older patients with cryptogenic events.METHODS: This multicentre international study included patients over 60 years undergoing PFO closure for cryptogenic thromboembolic events. A dedicated database compiled baseline, procedural, and follow-up data. Competing risk and adjusted outcome predictor analyses were conducted.RESULTS: A total of 689 patients were included (median age 65 years, 41.2% female, mean Risk of Paradoxical Embolism [RoPE] score 4.5). The procedural success rate was 99.4%. After a median follow-up of 2 (interquartile range 1-5) years, 66 patients (9.6%) had died. CVE and stroke rates were 1.21 and 0.55 per 100 patient-years, respectively. Diabetes (hazard ratio [HR] 3.89, 95% confidence interval [CI]: 1.67-9.07; p=0.002) and atrial septal aneurysm (ASA; HR 5.25, 95% CI: 1.56-17.62; p=0.007) increased the CVE risk. New-onset AF occurred at a rate of 3.30 per 100 patient-years, with 51.3% within one month post-procedure. Older age (HR 1.05 per year, 95% CI: 1.00-1.09; p=0.023) and the absence of hypertension (HR 2.04, 95% CI: 1.19-3.57; p=0.010) were associated with an increased risk of AF.CONCLUSIONS: Older patients undergoing PFO closure had a relatively low rate of CVE and new-onset AF after a median follow-up of 2 years. The presence of diabetes, ASA, and a more advanced age determined an increased risk of adverse clinical events. These factors may be considered in the clinical decision-making process regarding PFO closure in this challenging population.
KW - cryptogenic thromboembolism
KW - elderly
KW - patent foramen ovale
KW - patent foramen ovale closure
KW - prior stroke
UR - https://www.scopus.com/pages/publications/85201619714
U2 - 10.4244/EIJ-D-24-00156
DO - 10.4244/EIJ-D-24-00156
M3 - Journal article
C2 - 39155753
SN - 1774-024X
VL - 20
SP - 1029
EP - 1038
JO - EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
JF - EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
IS - 16
ER -