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Risk of Ischemic Stroke After PFO Closure
Quick Takes
- The current retrospective analysis from national Danish registries looked to assess the risk of recurrent stroke among patients who underwent PFO closure for cryptogenic stroke and compared these rates to the general population.
- PFO closure for cryptogenic stroke identified patients who were at a higher risk of recurrent stroke compared to age and sex matched general population who had not had a PFO closure (aHR, 6.3; 95% CI, 3.1–12.6).
Study Questions:
What is the risk of stroke recurrence after patent foramen ovale (PFO) closure in routine clinical practice?
Methods:
The investigators used nationwide population-based Danish registries to conduct a cohort study of all patients with PFO closure during 2008–2021 (n = 1,162) and a birth year and sex-matched comparison cohort from the general population (n = 11,620). They calculated absolute and relative risks of ischemic stroke within 4 years after PFO closure. They used weighted Cox regression to estimate adjusted hazard ratios (aHRs) of the association between PFO closure versus the general population and ischemic stroke.
Results:
The absolute risks of ischemic stroke in patients with PFO closure and in the general population, respectively, were 1.4% (95% confidence interval [CI], 0.8–2.3%) and 0.1% (95% CI, 0.0–0.1%) at 1 year, 1.4% (95% CI, 0.8–2.3%) and 0.2% (95% CI, 0.2–0.4%) at 2 years, 2.2% (95% CI, 1.3–3.5%) and 0.4% (95% CI, 0.2–0.5%) at 3 years, and 2.5% (95% CI, 1.5–4.0%) and 0.4% (95% CI, 0.3–0.6%) at 4 years. Thus, the absolute 4-year risk of ischemic stroke was 2.1% (95% CI, 0.9–3.3%) higher in patients with PFO closure than in the general population, corresponding to an aHR of 6.3 (95% CI, 3.1–12.6).
Conclusions:
The 4-year risk of ischemic stroke after routine PFO closure for cryptogenic stroke was comparable to that observed in clinical trials, but remained higher than in the general population.
Perspective:
The current retrospective analysis from national Danish registries looked to assess the risk of recurrent stroke among patients who underwent PFO closure for cryptogenic stroke and compared these rates to the general population. The authors summarized that PFO closure for cryptogenic stroke identified patients who were at a higher risk of recurrent stroke compared to age- and sex-matched general population who had not had a PFO closure (aHR, 6.3; 95% CI, 3.1–12.6). It is challenging to draw firm conclusions given the trial design and its inherent limitations, but findings suggest that patients who have undergone PFO closure for cryptogenic stroke may have higher ‘residual risk’ for recurrent cerebrovascular accident. Further study to better understand what is driving the residual risk and its management is warranted.
Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Congenital Heart Disease, Vascular Medicine
Keywords: Foramen Ovale, Patent, Heart Defects, Congenital, Ischemic Stroke
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