Back to Search
Start Over
Revival of transcatheter PFO closure: A meta-analysis of randomized controlled trials - impact of shunt size and age
- Source :
- Reinthaler, M.; Ozga, A.-K.; Sinning, D.; Curio, J.; Al-Hindwan, H.S.; Baeckemo-Johansson, J.; Jung, F.; Lendlein, A.; Rauch, G.; Landmesser, U.: Revival of transcatheter PFO closure: A meta-analysis of randomized controlled trials-impact of shunt size and age. In: American Heart Journal. Vol. 201 (2018) 95-102. (DOI: /10.1016/j.ahj.2018.03.025)
- Publication Year :
- 2018
- Publisher :
- Elsevier, 2018.
-
Abstract
- Background Transcatheter foramen ovale closure (TPC) has emerged as a potential treatment option for patients with cryptogenic strokes and persistent foramen ovale (PFO). However, previous randomized controlled trials could hardly demonstrate any benefit compared to medical treatment (Med-Tx). Recently new data have become available which may change current practice of transcatheter PFO closure. Methods A systematic review and meta-analysis comparing TPC and Med-Tx based on all available multicentric randomized controlled trials was performed. The primary outcome of interest was the recurrence of stroke in both groups. Results Five studies met the inclusion criteria with 1829 patients in the TPC and 1622 in the Med-Tx group. The median follow-up was 4 years. In the intention-to-treat analysis we found a statistically significant relative risk reduction in recurrence of strokes in the TPC group compared to the Med-Tx group (pooled hazard ratio (HR): 0.32; 95% CI: 0.13–0.8; P = .018). Excluding one study due to potential publication bias resulted in a pooled HR of 0.48 (95% CI: 0.25–0.91, P = .024). Patients younger than 45 years of age (pooled HR: 0.35; 95% CI: 0.16–0.75; P = .007) and those with moderate to severe shunt (pooled HR: 0.28; 95% CI: 0.14–0.55; P < .001) were more likely to benefit from closure. Conclusion According to our meta-analysis TPC plus antiplatelets was superior in terms of stroke prevention when compared to Med-Tx. Furthermore, patients with moderate to severe shunts and those younger than 45 years of age were found to benefit most from TPC.
- Subjects :
- Relative risk reduction
Reoperation
medicine.medical_specialty
Cardiac Catheterization
Septal Occluder Device
Foramen Ovale, Patent
030204 cardiovascular system & hematology
law.invention
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
Internal medicine
Secondary Prevention
Medicine
Humans
030212 general & internal medicine
Randomized Controlled Trials as Topic
Intention-to-treat analysis
business.industry
Hazard ratio
Publication bias
Intention to Treat Analysis
Stroke
Meta-analysis
Foramen ovale closure
Cardiology and Cardiovascular Medicine
business
Shunt (electrical)
Subjects
Details
- Language :
- English
- ISSN :
- 00028703
- Database :
- OpenAIRE
- Journal :
- Reinthaler, M.; Ozga, A.-K.; Sinning, D.; Curio, J.; Al-Hindwan, H.S.; Baeckemo-Johansson, J.; Jung, F.; Lendlein, A.; Rauch, G.; Landmesser, U.: Revival of transcatheter PFO closure: A meta-analysis of randomized controlled trials-impact of shunt size and age. In: American Heart Journal. Vol. 201 (2018) 95-102. (DOI: /10.1016/j.ahj.2018.03.025)
- Accession number :
- edsair.doi.dedup.....2d1077f89e1c4c28ac7efad48fd00198