title: Comparison of Outcomes after Device Closure and Medication Alone in Patients with Patent Foramen Ovale and Cryptogenic Stroke in Korean Population.
abstract: OBJECTIVE
  To compare the effectiveness of device closure and medical therapy in prevention of recurrent embolic event in the Korean population with cryptogenic stroke and patent foramen ovale (PFO).
  
  
  METHODS
  Consecutive 164 patients (men: 126 patients, mean age: 48.1 years, closure group: 72 patients, medical group: 92 patients) were enrolled. The primary end point was a composite of death, stroke, transient ischemic attack (TIA), or peripheral embolism.
  
  
  RESULTS
  Baseline characteristics were similar in the two groups, except age, which was higher in the medical group (45.3±9.8 vs. 50.2±6.1, p<0.0001), and risk of paradoxical embolism score, which was higher in the closure group (6.2±1.6 vs. 5.7±1.3, p=0.026). On echocardiography, large right-to-left shunt (81.9% vs. 63.0%, p=0.009) and shunt at rest/septal hypermobility (61.1% vs. 23.9%, p<0.0001) were more common in the closure group. The device was successfully implanted in 71 (98.6%) patients. The primary end point occurred in 2 patients (2 TIA, 2.8%) in the closure group and in 2 (1 death, 1 stroke, 2.2%) in the medical group. Event-free survival rate did not differ between the two groups.
  
  
  CONCLUSIONS
  Compared to medical therapy, device closure of PFO in patients with cryptogenic stroke did not show difference in reduction of recurrent embolic events in the real world's setting. However, considering high risk of echocardiographic findings in the closure group, further investigation of the role of PFO closure in the Asian population is needed.
authors.affiliation: Cardiology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, Korea.
authors.forename: Jeonggeun
authors.initials: J
authors.lastname: Moon
authors.affiliation: Cardiology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, Korea. kangwch@gilhospital.com.
authors.forename: Woong Chol
authors.initials: WC
authors.lastname: Kang
authors.affiliation: Cardiology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, Korea.
authors.forename: Sihoon
authors.initials: S
authors.lastname: Kim
authors.affiliation: Cardiology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, Korea.
authors.forename: Pyung Chun
authors.initials: PC
authors.lastname: Oh
authors.affiliation: Cardiology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, Korea.
authors.forename: Yae Min
authors.initials: YM
authors.lastname: Park
authors.affiliation: Cardiology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, Korea.
authors.forename: Wook-Jin
authors.initials: WJ
authors.lastname: Chung
authors.affiliation: Department of Pediatrics, Gachon University, Gil Medical Center, Incheon, Korea.
authors.forename: Deok Young
authors.initials: DY
authors.lastname: Choi
authors.affiliation: Department of Anesthesiology, Gachon University, Gil Medical Center, Incheon, Korea.
authors.forename: Ji Yeon
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Neurology, Gachon University, Gil Medical Center, Incheon, Korea.
authors.forename: Yeong-Bae
authors.initials: YB
authors.lastname: Lee
authors.affiliation: Department of Radiology, Gachon University, Gil Medical Center, Incheon, Korea.
authors.forename: Hee Young
authors.initials: HY
authors.lastname: Hwang
authors.affiliation: Department of Anesthesiology, Gachon University, Gil Medical Center, Incheon, Korea.
authors.forename: Taehoon
authors.initials: T
authors.lastname: Ahn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects; D018572:Disease-Free Survival; D004617:Embolism / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D054092:Foramen Ovale, Patent / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D012306:Risk; D055502:Secondary Prevention / Q000379:methods; D055989:Septal Occluder Device / Q000009:adverse effects; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: Patent foramen ovale; device closure; ischemic strokes; transient ischemic attack