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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Device closure of patent foramen ovale versus medical therapy in cryptogenic stroke: A systematic review and meta-analysis
JACC: Cardiovascular Interventions, Volume 6, No. 12, Year 2013
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Description
Objectives This study sought to perform a meta-analysis of randomized controlled trials comparing device closure with medical therapy in the prevention of recurrent neurological events in patients with cryptogenic stroke and patent foramen ovale. Background The optimal strategy for secondary prevention of cryptogenic stroke with a patent foramen ovale is unclear. Methods Several databases were searched from their inception to March 2013, which yielded 3 eligible studies. The results were pooled as per the different patient populations defined in the studies: - intention-to-treat, per-protocol, and as-treated cohorts. A generic inverse method was used based on time-to-event outcomes in a fixed-effect model. A supplementary analysis pooled the results from only 2 trials (RESPECT [Randomized Evaluation of Recurrent Stroke Comparing PFO Closure to Established Current Standard of Care Treatment] and PC Trial [Randomized Clinical Trial Comparing the Efficacy of Percutaneous Closure of Patent Foramen Ovale (PFO) With Medical Treatment in Patients With Cryptogenic Embolism]) as a similar device was used in them. Results Our meta-analysis yielded effect-estimate hazard ratios of 0.67 (95% confidence interval [CI]: 0.44 to 1.00, I2 = 0%) in the intention-to-treat cohort, 0.62 (95% CI: 0.40 to 0.95). I2 = 0%) in the per-protocol cohort, and 0.61 (95% CI: 0.40 to 0.95, I2 = 38%) in the as-treated cohort, showing beneficial effects of device closure. The results became more robust with pooled results from RESPECT and the PC Trial: The effect-estimate hazard ratios being 0.54 (95% CI: 0.29 to 1.01, I2 = 0%), 0.48 (95% CI: 0.24 to 0.94, I2 = 26%), and 0.42 (95% CI: 0.21 to 0.84, I2 = 26%) in the intention-to-treat, per-protocol, and as-treated populations, respectively. Conclusions Our meta-analysis suggests that PFO closure is beneficial as compared to medical therapy in the prevention of recurrent neurological events. This meta-analysis helps to further strengthen the role of device closure in cryptogenic stroke. © 2013 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION PUBLISHED BY ELSEVIER INC.
Authors & Co-Authors
Khan, Abdur Rahman
United States, Toledo
The University of Toledo Medical Center
Bin Abdulhak, Aref A.
United States, Kansas City
University of Missouri-kansas City
Sheikh, Mujeeb Abdul
United States, Toledo
The University of Toledo Medical Center
Khan, Sobia
United States, Toledo
The University of Toledo Medical Center
Erwin, Patricia J.
United States, Rochester
Mayo Clinic
Tleyjeh, Imad M.
Saudi Arabia, Riyadh
King Fahad Medical City
United States, Rochester
Mayo Clinic
Khuder, Sadik
United States, Toledo
The University of Toledo Medical Center
Eltahawy, Ehab A.
United States, Toledo
The University of Toledo Medical Center
Statistics
Citations: 104
Authors: 8
Affiliations: 4
Identifiers
Doi:
10.1016/j.jcin.2013.08.001
ISSN:
19368798
e-ISSN:
18767605
Research Areas
Environmental
Health System And Policy
Noncommunicable Diseases
Study Design
Randomised Control Trial
Cohort Study
Study Approach
Systematic review