AUTHOR=Chen Po-Lin , Wang Chi-Sheng , Huang Jin-An , Fu Yun-Ching , Liao Nien-Chen , Hsu Chiann-Yi , Wu Yu-Hsuan 

TITLE=Patent foramen ovale closure in non-elderly and elderly patients with cryptogenic stroke: a hospital-based cohort study

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1190011

DOI=10.3389/fneur.2023.1190011

ISSN=1664-2295

ABSTRACT=Background
The efficacy of patent foramen ovale (PFO) closure in the elderly population is unclear. We aim to investigate the efficacy and safety of PFO closure in non-elderly and elderly patients.
Methods
Patients over 18 years of age with CS and PFO were prospectively enrolled and classified into two groups according to treatment: (1) closure of PFO (PFOC group) and (2) medical treatment alone (non-PFOC group). The primary outcome was a composite of recurrent cerebral ischemic events and all-cause mortality during the follow-up period. A modified Ranking Scale [mRS] at 180 days was recorded. The safety outcomes were procedure-related adverse events and periprocedural atrial fibrillation. The results between the PFOC and non-PFOC groups in non-elderly (<60 years) and elderly (≧60 years) patients were compared.
Results
We enrolled 173 patients, 78 (45%) of whom were elderly. During a mean follow-up of 2.5 years, the incidence of primary outcome was significantly lower in the PFOC group (6.2% vs. 17.1%, hazard ratio[HR]=0.35, 95%CI 0.13–0.97, p=0.043) in adjusted Cox regression analysis. Compared with the non-PFOC group, the PFOC group had a numerically lower risk of the primary outcome in both the elderly (HR 0.26, 95%CI 0.07–1.01, p=0.051) and the non-elderly (HR 0.61, 95%CI 0.11–3.27, p=0.574) groups. In addition, patients with PFO closure in the elderly group had a lower median mRS at 180 days (p=0.002). The rate of safety outcome was similar between the non-elderly and elderly groups.
Conclusions
PFO closure was associated with a reduced risk of the primary outcome in patients with PFO and CS in our total cohort, which included non-elderly and elderly patients. Compared to those without PFO closure, elderly patients with PFO closure had a better functional outcome at 180 days. PFO closure might be considered in selected elderly patients with PFO.