Residual Shunt After Patent Foramen Ovale Closure and Long-Term Stroke Recurrence: A Prospective Cohort Study.
Residual Shunt After Patent Foramen Ovale Closure and Long-Term Stroke Recurrence: A Prospective Cohort Study.
复制标题
专利孔卵形闭合和长期中风复发后的残留分流：一项前瞻性队列研究。
DOI：
10.7326/m19-3583
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发表时间：
2020-06-02
影响因子：
39.2
通讯作者：
Ning M
中科院分区：
文献类型：
--
作者：
Deng W;Yin S;McMullin D;Inglessis-Azuaje I;Elmariah S;Hung J;Lo EH;Palacios IF;Buonanno FS;Ning M
卵圆孔未闭 (PFO) 封堵后，高达 25% 的患者观察到残余分流，但其对中风复发的长期影响目前尚不清楚。探讨 PFO 封堵后残余分流与卒中复发和短暂性脑缺血发作 (TIA) 发生率的关系。前瞻性队列研究比较 PFO 闭合后有和没有残余分流患者的中风或 TIA 复发情况。单一医院中心。对 1078 名连续接受经皮 PFO 封堵术的 PFO 引起的隐源性中风患者（平均年龄 49.3 岁）进行了长达 11 年的随访。通过经胸超声心动图和盐水对比来评估残余分流。主要结局是 PFO 闭合后首次复发缺血性卒中或 TIA 的综合结果。与完全封堵相比，PFO封堵后残余分流的存在与复发性卒中或TIA的发生率增加相关：每100患者年分别有2.32个事件和0.75个事件（风险比[HR]，3.05 [95% CI，1.65至5.62]；P < 0.001）。在调整重要的协变量（即年龄）后，这一结果仍然稳健；学习期间；设备;存在房间隔动脉瘤、高血压、高脂血症、糖尿病、高凝状态或房间隔过度活动；和药物使用（HR，3.01 [CI，1.59 至 5.69]；P < 0.001）。根据分流大小的进一步分层显示，中度或大量残余分流与中风或 TIA 复发风险较高相关（HR，4.50 [CI，2.20 至 9.20]；P < 0.001）；小残余分流的结果是不确定的（HR，2.02 [CI，0.87 至 4.69]；P = 0.102）。非随机研究，具有潜在的无法测量的混杂因素。在接受 PFO 封堵术以预防未来中风的患者中，残余分流的存在，特别是中度或大量残余分流，与中风或 TIA 复发风险增加相关。美国国立卫生研究院。
Residual shunt is observed in up to 25% of patients after patent foramen ovale (PFO) closure, but its long-term influence on stroke recurrence currently is unknown. To investigate the association of residual shunt after PFO closure with the incidence of recurrent stroke and transient ischemic attack (TIA). Prospective cohort study comparing stroke or TIA recurrence in patients with and without residual shunt after PFO closure. Single hospital center. 1078 consecutive patients (mean age, 49.3 years) with PFO-attributable cryptogenic stroke who were undergoing percutaneous PFO closure were followed for up to 11 years. Residual shunt was evaluated by transthoracic echocardiography with saline contrast. Primary outcome was a composite of the first recurrent ischemic stroke or TIA after PFO closure. Compared with complete closure, the presence of residual shunt after PFO closure was associated with an increased incidence of recurrent stroke or TIA: 2.32 versus 0.75 events per 100 patient-years (hazard ratio [HR], 3.05 [95% CI, 1.65 to 5.62]; P < 0.001). This result remained robust after adjustment for important covariates, namely age; study period; device; presence of atrial septal aneurysm, hypertension, hyperlipidemia, diabetes, hypercoagulability, or hypermobile septum; and medication use (HR, 3.01 [CI, 1.59 to 5.69]; P < 0.001). Further stratification based on shunt size revealed that moderate or large residual shunts were associated with a higher risk for stroke or TIA recurrence (HR, 4.50 [CI, 2.20 to 9.20]; P < 0.001); the result for small residual shunts was indeterminate (HR, 2.02 [CI, 0.87 to 4.69]; P = 0.102). Nonrandomized study with potential unmeasured confounding. Among patients undergoing PFO closure to prevent future stroke, the presence of residual shunt, particularly a moderate or large residual shunt, was associated with an increased risk for stroke or TIA recurrence. National Institutes of Health.