Patent foramen ovale and long-term risk of ischaemic stroke after surgery.
Adult
Aged
Brain Ischemia
/ prevention & control
Case-Control Studies
Contrast Media
/ administration & dosage
Drug Therapy, Combination
Echocardiography, Transesophageal
/ adverse effects
Embolism, Paradoxical
/ etiology
Female
Fibrinolytic Agents
/ therapeutic use
Foramen Ovale, Patent
/ complications
Humans
Male
Middle Aged
Perioperative Period
Postoperative Care
/ methods
Risk Factors
Sensitivity and Specificity
Stroke
/ pathology
Antithrombotic agents
Paradoxical embolism
Patent foramen ovale
Stroke
Surgery
Journal
European heart journal
ISSN: 1522-9645
Titre abrégé: Eur Heart J
Pays: England
ID NLM: 8006263
Informations de publication
Date de publication:
14 03 2019
14 03 2019
Historique:
received:
20
03
2018
revised:
23
04
2018
accepted:
22
06
2018
pubmed:
19
7
2018
medline:
19
8
2020
entrez:
19
7
2018
Statut:
ppublish
Résumé
Pre-operatively diagnosed patent foramen ovale (PFO) is associated with an increased risk of ischaemic stroke within 30 days after surgery. This study aimed to assess the PFO-attributable ischaemic stroke risk beyond the perioperative period. This observational study of adult patients without history of stroke undergoing non-cardiac surgery with general anaesthesia examined the association of PFO with ischaemic stroke 1 and 2 years after surgery using multivariable logistic regression. Of the 144 563 patients included, a total of 1642 (1.1%) and 2376 (1.6%) ischaemic strokes occurred within 1 and 2 years after surgery, 54 (4.7%) and 76 (6.6%) among patients with PFO, and 1588 (1.1%) and 2300 (1.6%) among patients without PFO, respectively. The odds of ischaemic stroke within 1 and 2 years after surgery were increased in patients with PFO: adjusted odds ratio (aOR) 2.01, 95% confidence interval (CI) 1.51-2.69; P < 0.001 and aOR 2.10, 95% CI 1.64-2.68; P < 0.001, respectively. Among patients who underwent contrast transoesophageal echocardiography, the frequency of PFO was 27%, and the increased stroke risk in patients with PFO was robust (aOR 3.80, 95% CI 1.76-8.23; P = 0.001 for year 1). The PFO-attributable risk was mitigated by post-operative prescription of combination antithrombotic therapy (odds ratio 0.41, 95% CI 0.22-0.75; P for interaction = 0.004). Patients with PFO are vulnerable to ischaemic stroke for an extended period of time after surgery. Physicians should consider implementing PFO screening protocols in patients scheduled for major non-cardiac surgery.
Identifiants
pubmed: 30020431
pii: 5055460
doi: 10.1093/eurheartj/ehy402
pmc: PMC6416532
doi:
Substances chimiques
Contrast Media
0
Fibrinolytic Agents
0
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
914-924Commentaires et corrections
Type : CommentIn
Informations de copyright
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.
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