Updated meta-analysis on the closure of patent foramen ovale in reduction of stroke rates: the defense-pfo trial does not change the scenario
Rev. bras. cir. cardiovasc
; 33(5): 511-521, Sept.-Oct. 2018. tab, graf
Artigo
em Inglês
| LILACS
| ID: biblio-977455
Biblioteca responsável:
BR1.1
ABSTRACT
Abstract Objective:
We aimed to analyze whether patent foramen ovale (PFO) closure reduces the risk of stroke, assessing also some safety outcomes after the publication of a new trial.Introduction:
The clinical benefit of closing a PFO has been an open question, so it is necessary to review the current state of published medical data in regards to this subject.Methods:
MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles were used to search for randomized controlled trials (RCTs) that reported any of the followingoutcomes:
stroke, death, major bleeding or atrial fibrillation. Six studies fulfilled our eligibility criteria and included 3560 patients (1889 for PFO closure and 1671 for medical therapy.Results:
The risk ration (RR) for stroke in the "closure" group compared with the "medical therapy" showed a statistically significant difference between the groups, favouring the "closure" group (RR 0.366; 95%CI 0.171-0.782, P=0.010). There was no statistically significant difference between the groups regarding the safety outcomes, death and major bleeding, but we observed an increase in the risk of atrial fibrillation in the "closure" group (RR 4.131; 95%CI 2.293-7.443, P<0.001). We also observed that the larger the proportion of effective closure, the lower the risk of stroke.Conclusion:
This meta-analysis found that stroke rates are lower with percutaneously implanted device closure than with medical therapy alone, being these rates modulated by the rates of hypertension, atrial septal aneurysm and effective closure. The publication of a new trial did not change the scenario in the medical literature.
Texto completo:
Disponível
Coleções:
Bases de dados internacionais
Contexto em Saúde:
Agenda de Saúde Sustentável para as Américas
/
ODS3 - Saúde e Bem-Estar
/
ODS3 - Meta 3.4 Reduzir as mortes prematuras devido doenças não transmissíveis
Problema de saúde:
Objetivo 9: Redução de doenças não transmissíveis
/
Meta 3.4: Reduzir as mortes prematuras devido doenças não transmissíveis
/
Doença Cardiovascular
/
Doença Cerebrovascular
/
Anomalias Congênitas e Cromossômicas
/
Outras Doenças Circulatórias
Base de dados:
LILACS
Assunto principal:
Acidente Vascular Cerebral
/
Forame Oval Patente
Tipo de estudo:
Ensaio clínico controlado
/
Estudo de etiologia
/
Revisão sistemática
Limite:
Humanos
Idioma:
Inglês
Revista:
Rev. bras. cir. cardiovasc
Assunto da revista:
Cardiologia
/
CIRURGIA GERAL
Ano de publicação:
2018
Tipo de documento:
Artigo
País de afiliação:
Brasil
Instituição/País de afiliação:
Pronto Socorro Cardiológico de Pernambuco/BR