TY - JOUR
T1 - Transcatheter closure of patent foramen ovale following cryptogenic stroke
T2 - An updated meta-analysis of randomized controlled trials
AU - Riaz, Haris
AU - Khan, Muhammad Shahzeb
AU - Schenone, Aldo L.
AU - Waheed, Anam A.
AU - Khan, Arooj Razzak
AU - Krasuski, Richard A.
N1 - Publisher Copyright:
© 2018
PY - 2018/5
Y1 - 2018/5
N2 - Background: Transcatheter closure of patent foramen ovale (PFO) after cryptogenic stroke has long been a contentious issue. Herein, we pool aggregate data examining safety and efficacy of transcatheter closure of PFO compared with medical therapy following initial cryptogenic stroke. Methods: We searched for randomized clinical trials (RCT) that compared device closure with medical management and reported on subsequent stroke and adverse events. Stroke was considered as the primary efficacy endpoint, whereas bleeding and atrial fibrillation were considered primary safety endpoints. Data were pooled by the random effects model and I2 was used to assess heterogeneity. Results: A total of 5 RCT investigating 3630 patients met inclusion criteria. Pooled analysis revealed that device closure compared to medical management was associated with a significant reduction in stroke (RR = 0.3, 95% CI = 0.02–0.57). There was, however, a significant increase in atrial arrhythmias with device therapy (RR = 4.8, 95% CI = 2.2–10.7). We found no increase in bleeding (RR = 0.80, 95% CI = 0.5–1.4), death (RR = 0.76, 95% CI = 0.3–1.99) or “any adverse events” (RR = 1.02, 95% CI = 0.85–1.23) with device therapy. Sub-group analysis revealed that device closure significantly reduced the incidence of the composite primary endpoint among patients who had moderate to large shunt sizes (RR = 0.22, 95% CI = 0.02–0.42). Conclusions: Transcatheter closure is associated with a significant reduction in the risk of stroke compared to medical management at the expense of an increased risk of atrial arrhythmias.
AB - Background: Transcatheter closure of patent foramen ovale (PFO) after cryptogenic stroke has long been a contentious issue. Herein, we pool aggregate data examining safety and efficacy of transcatheter closure of PFO compared with medical therapy following initial cryptogenic stroke. Methods: We searched for randomized clinical trials (RCT) that compared device closure with medical management and reported on subsequent stroke and adverse events. Stroke was considered as the primary efficacy endpoint, whereas bleeding and atrial fibrillation were considered primary safety endpoints. Data were pooled by the random effects model and I2 was used to assess heterogeneity. Results: A total of 5 RCT investigating 3630 patients met inclusion criteria. Pooled analysis revealed that device closure compared to medical management was associated with a significant reduction in stroke (RR = 0.3, 95% CI = 0.02–0.57). There was, however, a significant increase in atrial arrhythmias with device therapy (RR = 4.8, 95% CI = 2.2–10.7). We found no increase in bleeding (RR = 0.80, 95% CI = 0.5–1.4), death (RR = 0.76, 95% CI = 0.3–1.99) or “any adverse events” (RR = 1.02, 95% CI = 0.85–1.23) with device therapy. Sub-group analysis revealed that device closure significantly reduced the incidence of the composite primary endpoint among patients who had moderate to large shunt sizes (RR = 0.22, 95% CI = 0.02–0.42). Conclusions: Transcatheter closure is associated with a significant reduction in the risk of stroke compared to medical management at the expense of an increased risk of atrial arrhythmias.
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U2 - 10.1016/j.ahj.2018.01.008
DO - 10.1016/j.ahj.2018.01.008
M3 - Article
C2 - 29754665
AN - SCOPUS:85042257240
SN - 0002-8703
VL - 199
SP - 44
EP - 50
JO - American heart journal
JF - American heart journal
ER -