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Beyond 55: Clinical Perspectives on Transcatheter PFO Closure - Insights from a Unicenter Study
Session:
Sessão de Posters 03 - Arritmias cardíacas e dispositivos percutâneos no risco cardioembólico
Speaker:
Ana L. Silva
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.6 Device Therapy - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Ana L. Silva; Mariana Rodrigues Simões; Rafaela Fernandes; Gonçalo Terleira Batista; Tatiana Pereira Dos Santos; Tomás Carlos; Ana Luísa Rocha; Mafalda Griné; Bernardo Resende; José Luís Martins; Marco Costa; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> Transcatheter patent foramen ovale (PFO) closure has emerged as a pivotal intervention for cryptogenic stroke. Despite strong evidence supporting its superiority over antithrombotic therapy alone, a significant knowledge gap persists due to the exclusion of patients aged over 60 years in major trials.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: Single-center, retrospective study. Patients who underwent percutaneous PFO closure from 2003 to 2023 were included. We aimed to compare procedural and long-term outcomes in two age groups: 55 years and older versus those younger than 55, focusing on stroke/transient ischemic attack (TIA), death, and new-onset atrial fibrillation (AF). Statistical analysis was performed using SPSS 28.0.1.1 software.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: A total of 378 patients were included, 55.9% female. The mean age was 60.6(±4.5) years in the older group (28.3%), and 42.5(±8.1) years in the younger group (71.7%). Statistically significant differences were found in cardiovascular risk factors (CVRF) at baseline: a higher prevalence of arterial hypertension (45.3% vs. 25.1%; p<0.001), dyslipidemia (61.1% vs. 39.9%; p<0.001), and diabetes (14.7% vs. 6.2%; p=0.012) in the older group. Previous stroke and TIA were present in 74.0% and 21.3%, respectively, similar in both groups (p=0.414).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">A large shunt (94.4%), long-tunnel (86.2%), and large-size (72.6%) were the most prevalent high-risk PFO features, with long-tunnel being significantly more frequent in the younger group (89.9% vs. 76.4%; p=0.002). The risk of paradoxical embolism (RoPE) score was significantly higher in patients younger than 55 (7.2±1.3 points) compared with the older patients (5.2±1.2 points; p<0.001).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">No notable differences in periprocedural complications were observed between the two groups (p=1.000). Two cases of periprocedural AF were identified, one in each group. Over a mean follow-up of 65(±54) months, 6 deaths occurred, with a slightly higher rate in the older group (3.0%) versus the younger (2.2%), though not statistically significant (p=0.353). For the composite of TIA/stroke, 6 events were recorded, notably higher in the older group (4.1%) than the younger (0.8%; p=0.050). Long-term AF was seen in 7 patients, more frequent in the older patients (4.2%) compared to the younger (1.2%), but this difference did not reach statistical significance (p=0.090). There were no TIA/stroke incidents in patients on oral anticoagulation.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions</strong>: In patients over 55 years, our findings suggest a trend toward more recurrent cerebrovascular events following PFO closure compared to the younger, possibly due to a higher burden of CVRF. However, the actual incidence of TIA/stroke in the older group was lower than predicted by the RoPE score, hinting at potential benefits. Randomized trials are necessary to assess PFO closure effectiveness in older patients, especially when compared to oral anticoagulation in this high-AF group.</span></span></p>
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