Percutaneous closure of patent foramen ovale in patients with cryptogenic embolism: a network meta-analysis.
Eur Heart J
; 36(2): 120-8, 2015 Jan 07.
Article
em En
| MEDLINE
| ID: mdl-25112661
ABSTRACT
BACKGROUND:
Up to 40% of ischaemic strokes are cryptogenic. A strong association between cryptogenic stroke and the prevalence of patent foramen ovale (PFO) suggests paradoxical embolism via PFO as a potential cause. Randomized trials failed to demonstrate superiority of PFO closure over medical therapy. METHODS ANDRESULTS:
Randomized trials comparing percutaneous PFO closure against medical therapy or devices head-to-head published or presented by March 2013 were identified through a systematic search. We performed a network meta-analysis to determine the effectiveness and safety of PFO closure with different devices when compared with medical therapy. We included four randomized trials (2963 patients with 9309 patient-years). Investigated devices were Amplatzer (AMP), STARFlex (STF), and HELEX (HLX). Patients allocated to PFO closure with AMP were less likely to experience a stroke than patients allocated to medical therapy [rate ratio (RR) 0.39; 95% CI 0.17-0.84]. No significant differences were found for STF (RR 1.01; 95% CI 0.44-2.41), and HLX (RR, 0.71; 95% CI 0.17-2.78) when compared with medical therapy. The probability to be best in preventing strokes was 77.1% for AMP, 20.9% for HLX, 1.7% for STF, and 0.4% for medical therapy. No significant differences were found for transient ischaemic attack and death. The risk of new-onset atrial fibrillation was more pronounced for STF (RR 7.67; 95% CI 3.25-19.63), than AMP (RR 2.14; 95% CI 1.00-4.62) and HLX (RR 1.33; 95%-CI 0.33-4.50), when compared with medical therapy.CONCLUSIONS:
The effectiveness of PFO closure depends on the device used. PFO closure with AMP appears superior to medical therapy in preventing strokes in patients with cryptogenic embolism.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Embolia Paradoxal
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Forame Oval Patente
Tipo de estudo:
Clinical_trials
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Etiology_studies
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Risk_factors_studies
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Systematic_reviews
Limite:
Adult
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Female
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Humans
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Male
Idioma:
En
Revista:
Eur Heart J
Ano de publicação:
2015
Tipo de documento:
Article
País de afiliação:
Suíça