Recurrent Stroke after Transcatheter PFO Closure in Cryptogenic Stroke or Tia: Long-Term Follow-Up
Table 4
Predictors of recurrent ischemic neurological events.
No. ischemic recurrence n (%)
Ischemic recurrence n (%)
OR
value
Age at PFO closure ≥ 55 years
116 (30.7)
14 (58.3)
3.16
0.007
Male
197 (52.1)
12 (50.0)
0.91
1.00
Cigarette smoking
156 (41.3)
15 (62.5)
2.37
0.054
Dyslipidemia
130 (34.4)
11 (45.8)
1.60
0.27
Hypertension
106 (28.0)
11 (45.8)
2.17
0.10
Diabetes mellitus
8 (2.1)
0
—
1.00
BMI > 25 Kg/m2
43 (11.4)
4 (16.7)
1.56
0.51
ASCVD
46 (12.2)
5 (20.8)
1.53
0.21
Index stroke
348 (92.1)
24 (100)
—
1.0
AF diagnosis at follow-up
19 (5.0)
2 (8.3)
1.72
0.36
Atrial septal aneurysm
195 (51.6)
15 (62.5)
1.56
0.40
Severe R→L shunt before device closure
373 (98.7)
24 (100)
1.10
1.00
Residual significant R→L shunt
14 (3.7)
0
0.92
1.00
RoPE score < 7
230 (60.8)
20 (83.3)
3.21
0.03
CHA2DS2-Vasc score ≥ 3
233 (61.6)
18 (75.0)
1.87
0.28
HATCH score ≥ 3
100 (26.5)
11 (45.8)
2.35
0.06
ATRIA score ≥ 9
226 (59.8)
18 (75.0)
2.02
0.19
Amplatzer devices
228 (60.3)
9 (37.5)
0.39
0.03
Multivariate Cox’s proportion hazard model identified age ≥ 55 years at the time of closure and RoPE score < 7 as predictors of recurrent neurological events. PFO closure performed with Amplatzer device resulted a protective factor. No association was observed between residual shunt and recurrent events. Residual significant (moderate or severe) R→L shunt: the last TCD ultrasonography or TTE with saline contrast injection was used to investigate the association between residual shunt and recurrent events. AF, atrial fibrillation; ASCVD, atherosclerotic cardiovascular disease; BMI, body mass index; L, left; R, right; TIA, transient ischemic attack.
