Age predicts recurrent cerebral ischemia after PFO closure

LONDON — Recurrent cerebral ischemia after patent foramen ovale closure is more likely to occur in patients aged 55 years and older, researchers reported at the European Society of Cardiology Congress 2015.

Recurrences are more likely related to age than to residual shunt or paradoxical embolism, Paolo Scacciatella, MD, from the cardiovascular and thoracic department of Azienda Ospedaliera Universitaria Citta della Salute e della Scienza, Turin, Italy, said during a presentation.

Scacciatella and colleagues investigated whether patients aged 55 and older had different long-term outcomes after PFO closure compared with younger patients. The study included 458 patients (151 aged 55 years and older) who underwent PFO closure at two referral centers from 2000 to 2013.

“The literature in patients older than 55 is very poor and very conflicting,” Scacciatella said during a presentation.

The primary endpoint was long-term recurrence of cerebral ischemia stratified by age. The secondary endpoint was a composite of death and device-related complications. Mean follow-up was 4.5 years.

Compared with the younger group, the older group was more likely to have hypertension, diabetes, dyslipidemia and CAD, Scacciatella and colleagues reported.

During the study period, recurrent cerebral ischemia occurred in 4% of the older group vs. 0.3% of the younger group (P = .002). Rates of stroke (2.6% vs. 0.3%; P = .02) and transient ischemic attack (1.4% vs. 0%; P = .04) were higher in the older group, according to Scacciatella.

“In none of the patients with recurrent cerebral ischemia have we been able to detect a shunt,” he said.

The data also revealed no major differences in all-cause death (0.7% for both; P = .98) or device-related complications (older group, 0%; younger group, 0.3%). No CV deaths occurred in either group. The younger group had a higher rate of event-free survival than the older group (P = .008).

According to multivariate analysis, age was the only independent predictor of the primary outcome (HR = 8.38; 95% CI, 1.5-83.2), according to the researchers.

“Based on this analysis, we can state that recurrent cerebral ischemia after PFO closure is more frequent in patients above 55 years of age,” he said. “This event occurring after closure is unrelated to residual shunt and paradoxical embolism, but is most likely related to the age itself.”

Scacciatella told Cardiology Today that “the results of the study underline the importance of accurate patient selection and monitoring of the underlying disease, particularly in patients aged more than 55.” – by Erik Swain

Reference:

Scacciatella P, et al. Abstract P208. Presented at: European Society of Cardiology Congress 2015; Aug. 29-Sept. 2; London.

Disclosure: Scacciatella reports no relevant financial disclosures.