Abstract 11716: Patent Foramen Ovale Closure vs Medical Therapy in Patients ≥ 60 Years of Age With Ischemic Stroke: A Retrospective Cohort Study

Abstract

Background: The benefit of patent foramen ovale (PFO) closure in patients aged ≥60 years with ischemic stroke is uncertain. Purpose: We conducted a retrospective cohort study to compare the outcomes of PFO closure vs medical therapy in this population. Methods: Using the TriNetX research database we identified patients ≥ 60 years with PFO who had an ischemic stroke from 2016 to 2021. Patients were divided into two groups: those undergoing PFO closure within 3 months of the stroke and those who received medical therapy only. Subgroup analyses was performed by age group (60 to 70 and ≥71). Propensity score matching was used to control for age, sex, hypertensive diseases, CKD, diabetes, dyslipidemias, ischemic heart disease, tobacco use, and neoplasms. Outcomes were measured from 1 month to 3 years after the index event and included all-cause mortality, new onset AF/flutter, arterial embolism, and services associated with stroke/embolism (thrombolysis, thrombectomy, administration of thrombolytics, and imaging of head and neck). Results: PFO closure was associated with lower number of services used in stroke/embolism (HR 0.57, 95%CI 0.42-0.78), a similar association was seen in those in the 60-70 age group (HR 0.539, 95%CI 0.373,0.78) but not in those ≥71 years. Arterial embolism was seen in 3.14% of the patients who received antiplatelets or anticoagulants only, but none of the patients who underwent PFO (Table 1) . Conclusions: PFO closure was associated with lower number of services used in stroke/embolism in patients aged ≥60 years with ischemic stroke. Our study could have been underpowered to find differences amongst those ≥71 years old. None of the patients who underwent PFO closure developed arterial embolism. PFO closure may be beneficial for older patients with ischemic stroke and warrant further investigation