TY - JOUR
T1 - Association of preoperatively diagnosed patent foramenovale with perioperative ischemic stroke
AU - Ng, Pauline Y.
AU - Ng, Andrew K.Y.
AU - Subramaniam, Balachundhar
AU - Burns, Sara M.
AU - Herisson, Fanny
AU - Timm, Fanny P.
AU - Rudolph, Maira I.
AU - Scheffenbichler, Flora
AU - Sabine, Friedrich
AU - Houle, Timothy T.
AU - Bhatt, Deepak L.
AU - Eikermann, Matthias
N1 - Funding Information:
completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Subramaniam reports receipt of grants from NIGMS (PI [primary investigator]), Mallinckrodt Pharmaceuticals, DL Biotech, and Edwards Lifesciences. Dr Houle reports receipt of grants from NINDS (PI) and NIGMS; personal fees from the journals Headache: The Journal of Head and Face Pain, and Anesthesiology for statistical consulting, and personal fees from Cephalagia for expedited peer review outside the submitted work. Dr Bhatt reports receipt of personal fees for advisory board services from Elsevier Practice Update Cardiology, and other for advisory board services from Cardax, Medscape Cardiology, Regado Biosciences; other for board of directors participation from the Boston VA Research Institute and personal fees and nonfinancial support for board of directors participation (travel reimbursement) from the Society of Cardiovascular Patient Care; other for unfunded research collaboration from FlowCo, PLx Pharma, Takeda, and Merck; personal fees (honoraria) for participating on data monitoring committees from Duke Clinical Research Institute (and clinical trial steering committees), Mayo Clinic, Population Health Research Institute (also operations committee, publications committee, and steering committee for Bayer-funded trial [COMPASS]), Harvard Clinical Research Institute (St. Jude–funded trial [PORTICO]; and Boehringer Ingelheim–funded executive steering committee participation), Cleveland Clinic, and Mount Sinai School of Medicine; honoraria for editing from the American College of Cardiology (and travel reimbursement), Belvoir Publications, Slack Publications, HMP Communications (Journal of Invasive Cardiology), the Journal of the American College of Cardiology, and other from Clinical Cardiology; personal fees for CME steering committee participation from WebMD; other for site coinvestigator services from St. Jude Medical, Biotronik, and Boston Scientific; travel reimbursement from the American Heart Association as chair of the quality oversight committee; other for NCDR-Action Registry steering committee and VA CART research and publications committee participation; and royalties from Elsevier; all outside the submitted work. Dr Eikermann reports receipt of grants from Merck; personal fees (honoraria) from Merck; funding from Jeffrey and Judith Buzen; and holds equity in Calabash Bioscience. No other disclosures were reported.
Publisher Copyright:
© 2018 American Medical Association. All rights reserved.
PY - 2018/2
Y1 - 2018/2
N2 - IMPORTANCE Perioperative stroke is a major complication for patients undergoing surgery. Patent foramen ovale (PFO) represents a possible anatomical link between venous thrombosis and stroke. OBJECTIVE To determine whether a preoperatively diagnosed PFO is associated with increased risk of perioperative ischemic stroke. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study from Massachusetts General Hospital and 2 affiliated community hospitals between January 1, 2007, and December 31, 2015. Participants were 182 393 consecutive adults undergoing noncardiac surgery with general anesthesia. EXPOSURES Preoperatively diagnosed PFO. MAIN OUTCOMES AND MEASURES Perioperative ischemic stroke occurring within 30 days of surgery; stroke subtype by Oxfordshire Community Stroke Project classification and stroke severity by National Institute of Health Stroke Scale (NIHSS). RESULTS Among the 150 198 patient cases analyzed (median [SD] age, 55 [16] years), 1540 (1.0%) had a diagnosis of PFO before surgery. A total of 850 (0.6%) ischemic strokes occurred within 30 days of surgery (49 [3.2%] among patients with PFO and 801 [0.5%] among patients without PFO). In adjusted analyses, patients with PFO had an increased risk of ischemic stroke compared with patients without PFO (odds ratio, 2.66 [95%CI, 1.96-3.63]; P < .001). The estimated risks of stroke were 5.9 for every 1000 patients with PFO and 2.2 for every 1000 patients without PFO (adjusted absolute risk difference, 0.4%[95%CI, 0.2%-0.6%). Patients with PFO also had an increased risk of large vessel territory stroke (relative risk ratio, 3.14 [95%CI, 2.21-4.48]; P < .001) and a more severe stroke-related neurologic deficit measured by NIHSS (median, 4 [interquartile range {IQR}, 2-10] vs median, 3 [IQR, 1-6] for those without PFO; P = .02). CONCLUSIONS AND RELEVANCE Among adult patients undergoing noncardiac surgery at 3 hospitals, having a preoperatively diagnosed PFO was significantly associated with increased risk of perioperative ischemic stroke within 30 days after surgery. Further research is needed to confirm these findings and to determine whether interventions would decrease this risk.
AB - IMPORTANCE Perioperative stroke is a major complication for patients undergoing surgery. Patent foramen ovale (PFO) represents a possible anatomical link between venous thrombosis and stroke. OBJECTIVE To determine whether a preoperatively diagnosed PFO is associated with increased risk of perioperative ischemic stroke. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study from Massachusetts General Hospital and 2 affiliated community hospitals between January 1, 2007, and December 31, 2015. Participants were 182 393 consecutive adults undergoing noncardiac surgery with general anesthesia. EXPOSURES Preoperatively diagnosed PFO. MAIN OUTCOMES AND MEASURES Perioperative ischemic stroke occurring within 30 days of surgery; stroke subtype by Oxfordshire Community Stroke Project classification and stroke severity by National Institute of Health Stroke Scale (NIHSS). RESULTS Among the 150 198 patient cases analyzed (median [SD] age, 55 [16] years), 1540 (1.0%) had a diagnosis of PFO before surgery. A total of 850 (0.6%) ischemic strokes occurred within 30 days of surgery (49 [3.2%] among patients with PFO and 801 [0.5%] among patients without PFO). In adjusted analyses, patients with PFO had an increased risk of ischemic stroke compared with patients without PFO (odds ratio, 2.66 [95%CI, 1.96-3.63]; P < .001). The estimated risks of stroke were 5.9 for every 1000 patients with PFO and 2.2 for every 1000 patients without PFO (adjusted absolute risk difference, 0.4%[95%CI, 0.2%-0.6%). Patients with PFO also had an increased risk of large vessel territory stroke (relative risk ratio, 3.14 [95%CI, 2.21-4.48]; P < .001) and a more severe stroke-related neurologic deficit measured by NIHSS (median, 4 [interquartile range {IQR}, 2-10] vs median, 3 [IQR, 1-6] for those without PFO; P = .02). CONCLUSIONS AND RELEVANCE Among adult patients undergoing noncardiac surgery at 3 hospitals, having a preoperatively diagnosed PFO was significantly associated with increased risk of perioperative ischemic stroke within 30 days after surgery. Further research is needed to confirm these findings and to determine whether interventions would decrease this risk.
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U2 - 10.1001/jama.2017.21899
DO - 10.1001/jama.2017.21899
M3 - Article
C2 - 29411032
AN - SCOPUS:85041679771
SN - 0002-9955
VL - 319
SP - 452
EP - 462
JO - JAMA - Journal of the American Medical Association
JF - JAMA - Journal of the American Medical Association
IS - 5
ER -