This was a multicenter study including 1136 consecutive patients who underwent PFO closure after a thromboembolic event. Patients were divided into 2 groups according to the type of event leading to PFO closure, ie, cerebrovascular event (CVE, n = 1099 [96.7%]) and NCPE (n = 37 [3.3%]). The median follow-up was 3 years (interquartile range, 1-8), with follow-up complete in 98%.
Patients in the NCPE group exhibited higher rates of prior or concomitant pulmonary embolism (29.7% vs 3.4%; P<.001), and prior myocardial infarction (24.3% vs 1.8%; P<.001). Most NCPE events were located in the limbs (41%), followed by coronary (27%) and renal/splenic/mesenteric arteries (12%). PFO closure was successful in all patients, with a low complication rate (<1%) in both groups. NCPE patients were more frequently treated with anticoagulation following PFO closure (63% vs 13%; P<.001). There were no differences between NCPE and CVE groups in death (0 per 100 patient years vs 0.4 per 100 patient-years; P=.53) or cerebrovascular events (1.3 per 100 patient-years vs 0.4 per 100 patient-years; P=.15) at follow-up.
Patients with NCPE events undergoing PFO closure exhibited differential baseline characteristics compared with patients with CVEs; limbs and coronary arteries were the most frequent NCPE location. PFO closure results and long-term outcomes were similar to their CVE counterparts, with a very low rate of recurrent thromboembolic events. Further studies are needed in this population.
方法:这是一项多中心研究,包括1136例血栓栓塞事件后接受PFO封堵的患者。根据导致PFO闭合的事件类型将患者分为2组,ie,脑血管事件(CVE,n=1099[96.7%])和NCPE(n=37[3.3%])。中位随访时间为3年(四分位距,1-8),98%的随访完成。
结果:NCPE组患者先前或合并肺栓塞的发生率更高(29.7%vs3.4%;P<.001),和既往心肌梗死(24.3%vs1.8%;P<.001)。大多数NCPE事件位于四肢(41%),其次是冠状动脉(27%)和肾/脾/肠系膜动脉(12%)。所有患者都成功封堵PFO,两组并发症发生率均较低(<1%)。在PFO闭合后,NCPE患者使用抗凝治疗的频率更高(63%vs13%;P<.001)。NCPE和CVE组在随访时死亡(0/100患者年vs0.4/100患者年;P=.53)或脑血管事件(1.3/100患者年vs0.4/100患者年;P=.15)没有差异。
结论:与CVE患者相比,发生NCPE事件的PFO封堵患者表现出不同的基线特征;肢体和冠状动脉是最常见的NCPE位置。PFO闭合结果和长期结果与CVE相似,血栓栓塞事件的复发率非常低。需要对这一人群进行进一步的研究。