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IMPACT OF MORPHOLOGY UPON RECURRENT NEUROLOGICAL EVENTS AFTER TRANSCATHETER CLOSURE OF PATENT FORAMEN OVALE: A META-ANALYSIS
E243 JACC March 27, 2012 Volume 59, Issue 13
ACC-i2 with TCT IMPACT OF MORPHOLOGY UPON RECURRENT NEUROLOGICAL EVENTS AFTER TRANSCATHETER CLOSURE OF PATENT FORAMEN OVALE: A META-ANALYSIS i2 Poster Contributions McCormick Place South, Hall A Saturday, March 24, 2012, 9:30 a.m.-Noon
Session Title: Structural Abstract Category: 18. PCI - Structural, PFO/ASD, Left Atrial Appendage, HOCM Presentation Number: 2534-144 Authors: Shikhar Agarwal, Navkaranbir Bajaj, E. Murat Tuzcu, Samir Kapadia, Cleveland Clinic, Cleveland, OH, USA Morphological features like PFO size, degree of shunting and coexistent atrial septal aneurysm (ASA) have been shown to impact the recurrent neurological events (RNE) after transcatheter PFO closure. Methods: We conducted a meta-analysis to study the role of shunt size and presence of ASA in prevention of RNE in patients undergoing transcatheter closure in comparison to those managed medically. Results: In the transcatheter closure arm, the incidence (95%CI) of RNE per 100 person-years among patients with PFO alone versus those with PFO and ASA was estimated as 0.40(0.10-0.60) events and 0.60(0.10-1.10) events respectively. In the medical management arm, the respective incidence of RNE per 100 person-years among patients with PFO alone and PFO and ASA was estimated as 2.40(0.90-4.00) events and 6.40(3.209.50) events respectively. In the transcatheter closure arm, there was no significant difference observed in RNE between the two morphological groups [RD (95%CI): 0.01(-0.01-0.02)]. However, in the medical management arm, there was significantly increased RNE observed in patients with PFO and ASA as compared to patients with PFO alone [RD (95%CI): 0.06(0.02-0.11)]. With an increasing proportion of patients with large shunts, a significant increase was lacking in the rate of RNE after transcatheter PFO closure. Although there was no apparent trend towards increasing RNE with increasing proportion of patients with large shunts in the medical arm and the transcatheter closure arm, the rate of RNE in the medical arm was significantly higher than the transcatheter arm in the corresponding shunt categories. Conclusions: We observed an increased rate of RNE among patients with PFO and ASA undergoing medical therapy compared to patients with PFO alone. In the transcatheter arm, there was no significant difference in the rate of RNE between the two subgroups, indicating a beneficial effect of closure in preventing RNE in patients with PFO and ASA. In addition, we observed that the rate of RNE was similar regardless of pre-treatment shunt size among patients undergoing transcatheter closure. This may serve to demonstrate the efficacy of transcatheter closure independent of the preclosure shunt size.
ACC-i2 with TCT IMPACT OF MORPHOLOGY UPON RECURRENT NEUROLOGICAL EVENTS AFTER TRANSCATHETER CLOSURE OF PATENT FORAMEN OVALE: A META-ANALYSIS i2 Poster Contributions McCormick Place South, Hall A Saturday, March 24, 2012, 9:30 a.m.-Noon
Session Title: Structural Abstract Category: 18. PCI - Structural, PFO/ASD, Left Atrial Appendage, HOCM Presentation Number: 2534-144 Authors: Shikhar Agarwal, Navkaranbir Bajaj, E. Murat Tuzcu, Samir Kapadia, Cleveland Clinic, Cleveland, OH, USA Morphological features like PFO size, degree of shunting and coexistent atrial septal aneurysm (ASA) have been shown to impact the recurrent neurological events (RNE) after transcatheter PFO closure. Methods: We conducted a meta-analysis to study the role of shunt size and presence of ASA in prevention of RNE in patients undergoing transcatheter closure in comparison to those managed medically. Results: In the transcatheter closure arm, the incidence (95%CI) of RNE per 100 person-years among patients with PFO alone versus those with PFO and ASA was estimated as 0.40(0.10-0.60) events and 0.60(0.10-1.10) events respectively. In the medical management arm, the respective incidence of RNE per 100 person-years among patients with PFO alone and PFO and ASA was estimated as 2.40(0.90-4.00) events and 6.40(3.209.50) events respectively. In the transcatheter closure arm, there was no significant difference observed in RNE between the two morphological groups [RD (95%CI): 0.01(-0.01-0.02)]. However, in the medical management arm, there was significantly increased RNE observed in patients with PFO and ASA as compared to patients with PFO alone [RD (95%CI): 0.06(0.02-0.11)]. With an increasing proportion of patients with large shunts, a significant increase was lacking in the rate of RNE after transcatheter PFO closure. Although there was no apparent trend towards increasing RNE with increasing proportion of patients with large shunts in the medical arm and the transcatheter closure arm, the rate of RNE in the medical arm was significantly higher than the transcatheter arm in the corresponding shunt categories. Conclusions: We observed an increased rate of RNE among patients with PFO and ASA undergoing medical therapy compared to patients with PFO alone. In the transcatheter arm, there was no significant difference in the rate of RNE between the two subgroups, indicating a beneficial effect of closure in preventing RNE in patients with PFO and ASA. In addition, we observed that the rate of RNE was similar regardless of pre-treatment shunt size among patients undergoing transcatheter closure. This may serve to demonstrate the efficacy of transcatheter closure independent of the preclosure shunt size.