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Long-Term Propensity-Score Matched Comparison of Percutaneous Closure of Patent Foramen Ovale with Medical Treatment after Paradoxical Embolism.
MedLine Citation:
PMID:  22238228     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Patients with ischemic stroke or transient ischemic attack (TIA) presumably related to patent foramen ovale (PFO) are at risk for recurrent cerebrovascular events. Differences in long-term clinical outcome were investigated among patients with percutaneous PFO closure as compared with medical treatment. METHODS AND RESULTS: Between 1994 and 2000, 308 consecutive patients with cerebrovascular events presumably related to PFO underwent either percutaneous PFO closure (150 patients) or medical treatment (158 patients). Patients were prospectively followed for up to 15 years. Seven patients were lost during follow-up. The primary outcome was a composite of stroke, TIA, or peripheral embolism. We analyzed 103 propensity score matched pairs of patients who underwent percutaneous PFO closure or medical treatment. At a median follow-up of 9 years, the primary composite outcome occurred in 11 patients slated to PFO closure (11%) and 22 patients slated to medical treatment (21%): HR=0.43, 95% CI 0.20-0.94, P=0.033. The treatment effect was driven by a decrease in the risk of TIA of 5% versus 14%, respectively: HR 0.31, 95% CI 0.10 to 0.94, P=0.039. The risk of all-cause (6% in both groups) and cardiovascular mortality (3% in both groups) appeared identical. CONCLUSIONS: In this long-term observational, propensity score matched study, percutaneous PFO closure was more effective than medical treatment for secondary prevention of recurrent cerebrovascular events among patients with PFO related TIA or stroke.
Authors:
Andreas Wahl; Peter Jüni; Marie-Luise Mono; Bindu Kalesan; Fabien Praz; Laura Geister; Lorenz Räber; Krassen Nedeltchev; Heinrich P Mattle; Stephan Windecker; Bernhard Meier
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-1-11
Journal Detail:
Title:  Circulation     Volume:  -     ISSN:  1524-4539     ISO Abbreviation:  -     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-1-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Bern University Hospital & University of Bern, Bern, Switzerland.
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