TY - JOUR
T1 - Patent foramen ovale closure versus medical therapy for stroke prevention
T2 - A systematic review and meta-analysis of randomized controlled trials
AU - Lai, Jenny Chi Ling
AU - Tse, Gary
AU - Wu, William K.K.
AU - Gong, Mengqi
AU - Bazoukis, George
AU - Wong, Wing Tak
AU - Wong, Sunny Hei
AU - Lampropoulos, Konstantinos
AU - Baranchuk, Adrian
AU - Tse, Lap Ah
AU - Xia, Yunlong
AU - Li, Guangping
AU - Wong, Martin C.S.
AU - Chan, Yat Sun
AU - Mu, Nan
AU - Dong, Mei
AU - Liu, Tong
AU - Doshi, Rajkumar
AU - Meier, Bernhard
N1 - Publisher Copyright:
© 2018 Lai JCL et al.
PY - 2018
Y1 - 2018
N2 - Background: Previous randomized trials on patent foramen ovale (PFO) closure versus medical therapy for stroke prevention were inconclusive. Recently, two new randomized trials and new findings from an extended follow-up of a previous trial have been published on this topic. We conducted a systematic review and meta-analysis of randomized trials comparing PFO closure with medical therapy for stroke prevention. Methods: PubMed and Cochrane Library were searched until 16 th September 2017.The following search terms were used for PubMed: »patent foramen ovale» AND (stroke OR embolism) and »randomized» AND »Trial». For Cochrane Library, the following terms were used: »patent foramen ovale» AND »closure» AND (stroke OR embolism). Results: A total of 91 and 55 entries were retrieved from each database using our search strategy respectively, of which six studies on five trials met the inclusion criteria. This meta-analysis included 1829 patients in the PFO closure arm (mean age: 45.3 years; 54% male) and 1972 patients in the medical therapy arm (mean age: 45.1 years; 51% male). The median follow-up duration was 50 ± 30 months. When compared to medical therapy, PFO closure significantly reduced primary endpoint events with a risk ratio [RR] of 0.60 (95% CI: 0.44-0.83, P < 0.0001; I 2: 15%). It also reduced stroke (RR: 0.50, 95% CI: 0.35-0.73, P < 0.0001; I 2: 32%) despite increasing the risk of atrial fibrillation/flutter (RR: 1.90, 95% CI: 1.23-2.93, P < 0.01; I 2: 43%). However, it did not reduce transient ischemic accident events (0.75; 95% CI: 0.51-1.10, P = 0.14; I 2: 0%), all-cause bleeding (RR: 0.89; 95% CI: 0.44-1.78, P = 0.74; I 2: 51%) or gastrointestinal complications (RR: 0.92; 95% CI: 0.32-2.70, P = 0.88; I 2: 0%). Conclusions: PFO closure significantly reduces risk of stroke when compared to medical treatment and should therefore be considered for stroke prevention in PFO patients.
AB - Background: Previous randomized trials on patent foramen ovale (PFO) closure versus medical therapy for stroke prevention were inconclusive. Recently, two new randomized trials and new findings from an extended follow-up of a previous trial have been published on this topic. We conducted a systematic review and meta-analysis of randomized trials comparing PFO closure with medical therapy for stroke prevention. Methods: PubMed and Cochrane Library were searched until 16 th September 2017.The following search terms were used for PubMed: »patent foramen ovale» AND (stroke OR embolism) and »randomized» AND »Trial». For Cochrane Library, the following terms were used: »patent foramen ovale» AND »closure» AND (stroke OR embolism). Results: A total of 91 and 55 entries were retrieved from each database using our search strategy respectively, of which six studies on five trials met the inclusion criteria. This meta-analysis included 1829 patients in the PFO closure arm (mean age: 45.3 years; 54% male) and 1972 patients in the medical therapy arm (mean age: 45.1 years; 51% male). The median follow-up duration was 50 ± 30 months. When compared to medical therapy, PFO closure significantly reduced primary endpoint events with a risk ratio [RR] of 0.60 (95% CI: 0.44-0.83, P < 0.0001; I 2: 15%). It also reduced stroke (RR: 0.50, 95% CI: 0.35-0.73, P < 0.0001; I 2: 32%) despite increasing the risk of atrial fibrillation/flutter (RR: 1.90, 95% CI: 1.23-2.93, P < 0.01; I 2: 43%). However, it did not reduce transient ischemic accident events (0.75; 95% CI: 0.51-1.10, P = 0.14; I 2: 0%), all-cause bleeding (RR: 0.89; 95% CI: 0.44-1.78, P = 0.74; I 2: 51%) or gastrointestinal complications (RR: 0.92; 95% CI: 0.32-2.70, P = 0.88; I 2: 0%). Conclusions: PFO closure significantly reduces risk of stroke when compared to medical treatment and should therefore be considered for stroke prevention in PFO patients.
KW - PFO closure
KW - Patent foramen ovale
KW - medical therapy
KW - stroke
UR - http://www.scopus.com/inward/record.url?scp=85053505659&partnerID=8YFLogxK
U2 - 10.5256/f1000research.14599.r30279
DO - 10.5256/f1000research.14599.r30279
M3 - Article
C2 - 30271571
AN - SCOPUS:85053505659
SN - 2046-1402
VL - 6
JO - F1000Research
JF - F1000Research
M1 - 2178
ER -