Efficacy of interventional closure versus drug therapy for patent foramen ovale with cryptogenic stroke

Objective To compare the efficacy of interventional closure versus drug therapy in treatment of patent foramen ovale (PFO) complicated with cryptogenic stroke (CS). Methods Clinical data of 167 patients with cerebral infarction or transient ischemic attack (TIA) complicated with PFO admitted in the...

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Autores principales:	KANG Xue, LI Haiyan, SUN Yangyang, HOU Liwei, CHEN Guisheng
Formato:	article
Lenguaje:	ZH
Publicado:	Editorial Office of Journal of Third Military Medical University 2021
Materias:	cryptogenic stroke patent foramen ovale closure prognosis Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/959cd795080b453a86f79f017dc44af3
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spelling	oai:doaj.org-article:959cd795080b453a86f79f017dc44af32021-11-28T11:00:46ZEfficacy of interventional closure versus drug therapy for patent foramen ovale with cryptogenic stroke10.16016/j.1000-5404.2021051001000-5404https://doaj.org/article/959cd795080b453a86f79f017dc44af32021-11-01T00:00:00Zhttp://aammt.tmmu.edu.cn/Upload/rhtml/202105100.htmhttps://doaj.org/toc/1000-5404Objective To compare the efficacy of interventional closure versus drug therapy in treatment of patent foramen ovale (PFO) complicated with cryptogenic stroke (CS). Methods Clinical data of 167 patients with cerebral infarction or transient ischemic attack (TIA) complicated with PFO admitted in the Department of Neurology, General Hospital of Ningxia Medical University from January 2015 to August 2019 were collected and analyzed retrospectively. Among them, 80 (the surgery group) underwent PFO interventional closure and antithrombotic drug administration, and the other 87 (the drug group) only received drug therapy (oral antiplatelet aggregation or anticoagulant drugs). All the patients were followed up for an average of 31.6 (12~67) months. According to occurrence of endpoint events (recurrent cerebral infarction, recurrent TIA and death), the patients were divided into endpoint event group (n=24) and non-endpoint event group (n=143). Univariate analysis was used to compare the general data between the 2 groups of patients, and multivariate analysis was used to screen independent risk factors for the recurrence of the endpoint events. Receiver operating characteristic (ROC) curve analysis was combined to evaluate the predictive values of obtained risk factors. Results The recurrence rate of the endpoint events was significantly lower in the surgery group than the drug group (Chi-square=10.959, P=0.001), and the patients with moderate and large shunts of PFO benefited more (Chi-square=10.26, P=0.001). Univariate analysis showed that the treatment method, follow-up time and history of obstructive sleep apnea (OSA) had statistical significances in the occurrence of endpoint events (P < 0.05); Multivariate logistic regression analysis showed that the independent risk factors affecting the prognosis of patients were drug therapy (OR=8.958, P=0.001, 95%CI: 2.475~32.422), follow-up time (OR=1.041, P=0.013, 95%CI: 1.009~1.075) and a history of OSA (OR=8.117, P=0.001, 95%CI: 2.247~29.324). ROC curve analysis showed that the area under the curve was 0.813 (95%CI: 0.737 to 0.889, P < 0.001) for the model with drug therapy, follow-up time, and OSA history as variables. The area under the curve was 0.767 (95%CI: 0.677~0.856, P < 0.001) for the model with drug therapy and OSA history as variables, and 0.764 (95%CI: 0.674~0.853, P < 0.001) for the model with drug therapy and follow-up time as variables. Conclusion For patients with PFO complicated with CS, interventional closure can reduce the risk of recurrence of the end point events, and the patients with moderate or large number of shunts of PFO benefit more. Active OSA intervention have a certain preventive effect on the recurrence of the endpoint events.KANG XueLI HaiyanSUN YangyangHOU LiweiCHEN GuishengCHEN GuishengEditorial Office of Journal of Third Military Medical Universityarticlecryptogenic strokepatent foramen ovaleclosureprognosisMedicine (General)R5-920ZHDi-san junyi daxue xuebao, Vol 43, Iss 22, Pp 2468-2473 (2021)
institution	DOAJ
collection	DOAJ
language	ZH
topic	cryptogenic stroke patent foramen ovale closure prognosis Medicine (General) R5-920
spellingShingle	cryptogenic stroke patent foramen ovale closure prognosis Medicine (General) R5-920 KANG Xue LI Haiyan SUN Yangyang HOU Liwei CHEN Guisheng CHEN Guisheng Efficacy of interventional closure versus drug therapy for patent foramen ovale with cryptogenic stroke
description	Objective To compare the efficacy of interventional closure versus drug therapy in treatment of patent foramen ovale (PFO) complicated with cryptogenic stroke (CS). Methods Clinical data of 167 patients with cerebral infarction or transient ischemic attack (TIA) complicated with PFO admitted in the Department of Neurology, General Hospital of Ningxia Medical University from January 2015 to August 2019 were collected and analyzed retrospectively. Among them, 80 (the surgery group) underwent PFO interventional closure and antithrombotic drug administration, and the other 87 (the drug group) only received drug therapy (oral antiplatelet aggregation or anticoagulant drugs). All the patients were followed up for an average of 31.6 (12~67) months. According to occurrence of endpoint events (recurrent cerebral infarction, recurrent TIA and death), the patients were divided into endpoint event group (n=24) and non-endpoint event group (n=143). Univariate analysis was used to compare the general data between the 2 groups of patients, and multivariate analysis was used to screen independent risk factors for the recurrence of the endpoint events. Receiver operating characteristic (ROC) curve analysis was combined to evaluate the predictive values of obtained risk factors. Results The recurrence rate of the endpoint events was significantly lower in the surgery group than the drug group (Chi-square=10.959, P=0.001), and the patients with moderate and large shunts of PFO benefited more (Chi-square=10.26, P=0.001). Univariate analysis showed that the treatment method, follow-up time and history of obstructive sleep apnea (OSA) had statistical significances in the occurrence of endpoint events (P < 0.05); Multivariate logistic regression analysis showed that the independent risk factors affecting the prognosis of patients were drug therapy (OR=8.958, P=0.001, 95%CI: 2.475~32.422), follow-up time (OR=1.041, P=0.013, 95%CI: 1.009~1.075) and a history of OSA (OR=8.117, P=0.001, 95%CI: 2.247~29.324). ROC curve analysis showed that the area under the curve was 0.813 (95%CI: 0.737 to 0.889, P < 0.001) for the model with drug therapy, follow-up time, and OSA history as variables. The area under the curve was 0.767 (95%CI: 0.677~0.856, P < 0.001) for the model with drug therapy and OSA history as variables, and 0.764 (95%CI: 0.674~0.853, P < 0.001) for the model with drug therapy and follow-up time as variables. Conclusion For patients with PFO complicated with CS, interventional closure can reduce the risk of recurrence of the end point events, and the patients with moderate or large number of shunts of PFO benefit more. Active OSA intervention have a certain preventive effect on the recurrence of the endpoint events.
format	article
author	KANG Xue LI Haiyan SUN Yangyang HOU Liwei CHEN Guisheng CHEN Guisheng
author_facet	KANG Xue LI Haiyan SUN Yangyang HOU Liwei CHEN Guisheng CHEN Guisheng
author_sort	KANG Xue
title	Efficacy of interventional closure versus drug therapy for patent foramen ovale with cryptogenic stroke
title_short	Efficacy of interventional closure versus drug therapy for patent foramen ovale with cryptogenic stroke
title_full	Efficacy of interventional closure versus drug therapy for patent foramen ovale with cryptogenic stroke
title_fullStr	Efficacy of interventional closure versus drug therapy for patent foramen ovale with cryptogenic stroke
title_full_unstemmed	Efficacy of interventional closure versus drug therapy for patent foramen ovale with cryptogenic stroke
title_sort	efficacy of interventional closure versus drug therapy for patent foramen ovale with cryptogenic stroke
publisher	Editorial Office of Journal of Third Military Medical University
publishDate	2021
url	https://doaj.org/article/959cd795080b453a86f79f017dc44af3
work_keys_str_mv	AT kangxue efficacyofinterventionalclosureversusdrugtherapyforpatentforamenovalewithcryptogenicstroke AT lihaiyan efficacyofinterventionalclosureversusdrugtherapyforpatentforamenovalewithcryptogenicstroke AT sunyangyang efficacyofinterventionalclosureversusdrugtherapyforpatentforamenovalewithcryptogenicstroke AT houliwei efficacyofinterventionalclosureversusdrugtherapyforpatentforamenovalewithcryptogenicstroke AT chenguisheng efficacyofinterventionalclosureversusdrugtherapyforpatentforamenovalewithcryptogenicstroke AT chenguisheng efficacyofinterventionalclosureversusdrugtherapyforpatentforamenovalewithcryptogenicstroke
_version_	1718408273731780608

Efficacy of interventional closure versus drug therapy for patent foramen ovale with cryptogenic stroke

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