title: Patent foramen ovale treatment strategy: an Italian large prospective study.
abstract: OBJECTIVE
  There is still controversy regarding the benefit of percutaneous closure of patent foramen ovale (PFO) among patients with cryptogenic stroke. Here we aimed to evaluate the factors associated with treatment choice and predictors of adverse events in patients with cryptogenic stroke or transient ischemic attack (TIA) and PFO.
  
  
  METHODS
  Of 418 consecutive patients with PFO and cryptogenic stroke or TIA, 262 underwent percutaneous PFO closure, whereas 156 were medically treated. Multivariable logistic regression models were developed to evaluate factors influencing the treatment strategy and predictors of outcome, a composite of stroke, TIA or all-cause mortality.
  
  
  RESULTS
  Patients with large interatrial right-to-left shunt were more likely treated with percutaneous closure [odds ratio (OR) = 4.79, 95% confidence interval (2.73-8.42); P < 0.0001], whereas those with multiple cerebrovascular accident (CVA) risk factors were more likely treated medically [OR = 0.15 (0.03-0.60); P = 0.023]. Age greater than 55 years [OR = 2.70 (1.05-6.88); P = 0.04], previous CVAs [OR = 2.49 (1.03-6.02); P = 0.02] and atrial septal aneurism [ASA, OR = 2.64 (1.09-6.39); P = 0.02], but not percutaneous closure of PFO [OR = 1.10 (0.44-2.74); P = 0.81], were independent predictors of outcome.
  
  
  CONCLUSIONS
  Among patients with cryptogenic stroke and PFO, the presence of large interatrial right-to-left shunt and multiple CVA risk factors influenced the treatment choice. Older age, multiple previous CVAs and ASA, but not PFO closure, independently predicted the composite outcome of cryptogenic stroke, TIA or all-cause mortality.
authors: aDivision of Cardiology, University of Turin, San Giovanni Battista Hospital, Turin, Italy bDivision of Cardiology, Maria Vittoria Hospital, Turin, Italy cDivision of Cardiology, Cardinal Massaia Hospital, Asti, Italy dDepartment of Neuroscience, San Giovanni Battista Hospital, Turin, Italy.
authors: Brunilda
authors: B
authors: Alushi
authors: Luigi
authors: L
authors: Biasco
authors: Fulvio
authors: F
authors: Orzan
authors: Pierluigi
authors: P
authors: Omedé
authors: Filippo
authors: F
authors: Sciuto
authors: Claudio
authors: C
authors: Moretti
authors: Riccardo
authors: R
authors: Belli
authors: Gianfranco
authors: G
authors: Defilippi
authors: Giulia
authors: G
authors: Barisone
authors: Paolo
authors: P
authors: Cerrato
authors: Fiorenzo
authors: F
authors: Gaita
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000517:prevention & control; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000925:Anticoagulants