Device Closure of Patent Foramen Ovale After Stroke: Pooled Analysis of Completed Randomized Trials.

Kent, David M; Dahabreh, Issa J; Ruthazer, Robin; Furlan, Anthony J; Reisman, Mark; Carroll, John D; Saver, Jeffrey L; Smalling, Richard W; Jüni, Peter; Mattle, Heinrich P; Meier, Bernhard; Thaler, David E (2016). Device Closure of Patent Foramen Ovale After Stroke: Pooled Analysis of Completed Randomized Trials. Journal of the American College of Cardiology, 67(8), pp. 907-917. Elsevier 10.1016/j.jacc.2015.12.023

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BACKGROUND The comparative effectiveness of percutaneous closure of patent foramen ovale (PFO) plus medical therapy versus medical therapy alone for cryptogenic stroke is uncertain. OBJECTIVES The authors performed the first pooled analysis of individual participant data from completed randomized trials comparing PFO closure versus medical therapy in patients with cryptogenic stroke. METHODS The analysis included data on 2 devices (STARFlex [umbrella occluder] [NMT Medical, Inc., Boston, Massachusetts] and Amplatzer PFO Occluder [disc occluder] [AGA Medical/St. Jude Medical, St. Paul, Minnesota]) evaluated in 3 trials. The primary composite outcome was stroke, transient ischemic attack, or death; the secondary outcome was stroke. We used log-rank tests and unadjusted and covariate-adjusted Cox regression models to compare device closure versus medical therapy. RESULTS Among 2,303 patients, closure was not significantly associated with the primary composite outcome. The difference became significant after covariate adjustment (hazard ratio [HR]: 0.68; p = 0.049). For the outcome of stroke, all comparisons were statistically significant, with unadjusted and adjusted HRs of 0.58 (p = 0.043) and 0.58 (p = 0.044), respectively. In analyses limited to the 2 disc occluder device trials, the effect of closure was not significant for the composite outcome, but was for the stroke outcome (unadjusted HR: 0.39; p = 0.013). Subgroup analyses did not identify significant heterogeneity of treatment effects. Atrial fibrillation was more common among closure patients. CONCLUSIONS Among patients with PFO and cryptogenic stroke, closure reduced recurrent stroke and had a statistically significant effect on the composite of stroke, transient ischemic attack, and death in adjusted but not unadjusted analyses.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Jüni, Peter; Mattle, Heinrich and Meier, Bernhard

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0735-1097

Publisher:

Elsevier

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

03 Jan 2017 14:01

Last Modified:

23 May 2017 16:06

Publisher DOI:

10.1016/j.jacc.2015.12.023

PubMed ID:

26916479

Uncontrolled Keywords:

cryptogenic stroke; meta-analysis; transient ischemic attack

BORIS DOI:

10.7892/boris.92378

URI:

https://boris.unibe.ch/id/eprint/92378

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