Julio Farjat-Pasos; Paul Guedeney; Eric Horlick; Jeremie Abtan; Luis Nombela-Franco; Benjamin Hibbert; Lars Søndergaard; Xavier Freixa; Jean-Bernard Masson; Ignacio Cruz-González; Rodrigo Estevez-Loureiro; Laurent Faroux; Ashish Shah; Lusine Abrahamyan; Jules Mesnier; Adrián Jerónimo; Omar Abdel-Razek; Troels Jørgensen; Mike Asmar; Samuel Sitbon; Mohammed Abalhassan; Mathieu Robichaud; Christine Houde; Melanie Cote; Angel Chamorro; Sylvain Lanthier; Steve Verreault; Gilles Montalescot; Josep Rodés-Cabau

doi:10.4244/EIJ-D-24-00156

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

Original Research

DOI: 10.4244/EIJ-D-24-00156

Determinants of adverse outcomes following patent foramen ovale closure in elderly patients

Julio I. Farjat-Pasos¹^,², MD, MSc; Paul Guedeney³, MD; Eric Horlick⁴, MD, PhD; Jeremie Abtan⁵, MD, PhD; Luis Nombela-Franco⁶, MD, PhD; Benjamin Hibbert⁷, MD, PhD; Lars Sondergaard⁸, MD, DMSc; Xavier Freixa⁹, MD, PhD; Jean-Bernard Masson¹⁰, MD; Ignacio Cruz-González¹¹, MD, PhD; Rodrigo Estévez-Loureiro¹², MD, PhD; Laurent Faroux¹³, MD, MSc; Ashish H. Shah¹⁴, MD; Lusine Abrahamyan⁴, MD, MPH; Jules Mesnier⁵, MD, PhD; Adrián Jerónimo⁶, MD; Omar Abdel-Razek⁷, MD, MSc; Troels Højsgaard Jørgensen⁸, MD, PhD; Mike Al Asmar¹⁰, MD; Samuel Sitbon⁵, MD; Mohammed Abalhassan⁷, MD; Mathieu Robichaud¹, MD, PharmD; Christine Houde², MD; Mélanie Côté¹, MSc; Angel Chamorro¹⁵, MD, PhD; Sylvain Lanthier¹⁶, MD; Steve Verreault¹⁷, MD; Gilles Montalescot³, MD, PhD; Josep Rodés-Cabau¹^,²^,⁹, MD, PhD

Abstract

BACKGROUND: Limited data are available on transcatheter patent foramen ovale (PFO) closure outcomes in the elderly.

AIMS: Through this study, we aimed to determine the incidence and predictors of adverse events (recurrent cerebrovascular events [CVE] and atrial fibrillation [AF]) post-PFO closure in older patients with cryptogenic events.

METHODS: This multicentre international study included patients over 60 years undergoing PFO closure for cryptogenic thromboembolic events. A dedicated database compiled baseline, procedural, and follow-up data. Competing risk and adjusted outcome predictor analyses were conducted.

RESULTS: A total of 689 patients were included (median age 65 years, 41.2% female, mean Risk of Paradoxical Embolism [RoPE] score 4.5). The procedural success rate was 99.4%. After a median follow-up of 2 (interquartile range 1-5) years, 66 patients (9.6%) had died. CVE and stroke rates were 1.21 and 0.55 per 100 patient-years, respectively. Diabetes (hazard ratio [HR] 3.89, 95% confidence interval [CI]: 1.67-9.07; p=0.002) and atrial septal aneurysm (ASA; HR 5.25, 95% CI: 1.56-17.62; p=0.007) increased the CVE risk. New-onset AF occurred at a rate of 3.30 per 100 patient-years, with 51.3% within one...

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