title: Long-term propensity score-matched comparison of percutaneous closure of patent foramen ovale with medical treatment after paradoxical embolism.
abstract: BACKGROUND
  Patients with ischemic stroke or transient ischemic attack presumably related to patent foramen ovale (PFO) are at risk for recurrent cerebrovascular events. Differences in long-term clinical outcome were investigated among patients with percutaneous PFO closure and those who received medical treatment.
  
  
  RESULTS
  Between 1994 and 2000, 308 consecutive patients with cerebrovascular events presumably related to PFO underwent either percutaneous PFO closure (150 patients) or medical treatment (158 patients). Patients were followed up prospectively for up to 15 years. Seven patients were lost during follow-up. The primary outcome was a composite of stroke, transient ischemic attack, or peripheral embolism. We analyzed 103 propensity score-matched pairs of patients who underwent percutaneous PFO closure or medical treatment. At a median follow-up of 9 years, the primary composite outcome occurred in 11 patients slated to PFO closure (11%) and 22 patients slated to medical treatment (21%; hazard ratio=0.43; 95% confidence interval=0.20-0.94; P=0.033). The treatment effect was driven by a decrease in the risk of transient ischemic attack of 5% versus 14%, respectively (hazard ratio=0.31; 95% confidence interval=0.10-0.94; P=0.039). The risk of all-cause (6% in both groups) and cardiovascular (3% in both groups) mortality appeared to be identical.
  
  
  CONCLUSIONS
  In this long-term observational, propensity score-matched study, percutaneous PFO closure was more effective than medical treatment for the secondary prevention of recurrent cerebrovascular events among patients with PFO-related transient ischemic attack or stroke.
authors.affiliation: Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Wahl
authors.forename: Peter
authors.initials: P
authors.lastname: Jüni
authors.forename: Marie-Luise
authors.initials: ML
authors.lastname: Mono
authors.forename: Bindu
authors.initials: B
authors.lastname: Kalesan
authors.forename: Fabien
authors.initials: F
authors.lastname: Praz
authors.forename: Laura
authors.initials: L
authors.lastname: Geister
authors.forename: Lorenz
authors.initials: L
authors.lastname: Räber
authors.forename: Krassen
authors.initials: K
authors.lastname: Nedeltchev
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D006328:Cardiac Catheterization; D002318:Cardiovascular Diseases / Q000401:mortality; D016022:Case-Control Studies; D003374:Coumarins / Q000627:therapeutic use; D004617:Embolism / Q000453:epidemiology / Q000517:prevention & control; D019320:Embolism, Paradoxical / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D054092:Foramen Ovale, Patent / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology* / Q000517:prevention & control; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000517:prevention & control; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D057216:Propensity Score; D016016:Proportional Hazards Models; D019919:Prosthesis Implantation / Q000379:methods*; D015641:Radiography, Interventional; D012189:Retrospective Studies; D055989:Septal Occluder Device / Q000706:statistics & numerical data; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control; D013557:Switzerland / Q000453:epidemiology
chemical_list: D000925:Anticoagulants; D003374:Coumarins; D010975:Platelet Aggregation Inhibitors; C030123:coumarin