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Updated meta-analysis on the closure of patent foramen ovale in reduction of stroke rates: the defense-pfo trial does not change the scenario
Sá, Michel Pompeu Barros Oliveira; Vieira, Erik Everton Silva; Cavalcanti, Luiz Rafael Pereira; Diniz, Roberto Gouveia Silva; Rayol, Sérgio da Costa; Menezes, Alexandre Motta de; Lins, Ricardo Felipe de Albuquerque; Lima, Ricardo Carvalho.
  • Sá, Michel Pompeu Barros Oliveira; Pronto Socorro Cardiológico de Pernambuco. Department of Cardiovascular Surgery. Recife. BR
  • Vieira, Erik Everton Silva; Pronto Socorro Cardiológico de Pernambuco. Department of Cardiovascular Surgery. Recife. BR
  • Cavalcanti, Luiz Rafael Pereira; Pronto Socorro Cardiológico de Pernambuco. Department of Cardiovascular Surgery. Recife. BR
  • Diniz, Roberto Gouveia Silva; Pronto Socorro Cardiológico de Pernambuco. Department of Cardiovascular Surgery. Recife. BR
  • Rayol, Sérgio da Costa; Pronto Socorro Cardiológico de Pernambuco. Department of Cardiovascular Surgery. Recife. BR
  • Menezes, Alexandre Motta de; Pronto Socorro Cardiológico de Pernambuco. Department of Cardiovascular Surgery. Recife. BR
  • Lins, Ricardo Felipe de Albuquerque; Pronto Socorro Cardiológico de Pernambuco. Department of Cardiovascular Surgery. Recife. BR
  • Lima, Ricardo Carvalho; Pronto Socorro Cardiológico de Pernambuco. Department of Cardiovascular Surgery. Recife. BR
Rev. bras. cir. cardiovasc ; 33(5): 511-521, Sept.-Oct. 2018. tab, graf
Article Dans Anglais | LILACS | ID: biblio-977455
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 following

outcomes:

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.
Sujets)


Texte intégral: Disponible Indice: LILAS (Amériques) Sujet Principal: Accident vasculaire cérébral / Foramen ovale perméable Type d'étude: Essai clinique contrôlé / Etude d'étiologie / Revues systématiques évaluées Limites du sujet: Humains langue: Anglais Texte intégral: Rev. bras. cir. cardiovasc Thème du journal: Cardiologie / Chirurgie générale Année: 2018 Type: Article Pays d'affiliation: Brésil Institution/Pays d'affiliation: Pronto Socorro Cardiológico de Pernambuco/BR

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Texte intégral: Disponible Indice: LILAS (Amériques) Sujet Principal: Accident vasculaire cérébral / Foramen ovale perméable Type d'étude: Essai clinique contrôlé / Etude d'étiologie / Revues systématiques évaluées Limites du sujet: Humains langue: Anglais Texte intégral: Rev. bras. cir. cardiovasc Thème du journal: Cardiologie / Chirurgie générale Année: 2018 Type: Article Pays d'affiliation: Brésil Institution/Pays d'affiliation: Pronto Socorro Cardiológico de Pernambuco/BR