卵圆孔未闭预防中风的闭包。一个简短的荟萃分析(P2.011)

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目的:评估经皮卵圆孔未闭是否关闭(卵圆孔未闭)+药物治疗比单独药物治疗复发有益预防中风和短暂性脑缺血发作(TIA)。背景:不明原因引起的中风是多达40%的急性缺血性中风。矛盾的血栓栓塞在卵圆孔未闭是一个潜在的机制。卵圆孔未闭关闭预防中风的功效还有待证实。设计/方法:我们进行了荟萃分析比较卵圆孔未闭关闭+药物治疗单独治疗中风或TIA患者和卵圆孔未闭,有或没有房间隔动脉瘤(ASA)。我们招收对象包括试验,60岁,与卵圆孔未闭的人不明原因引起的缺血性中风或TIA和随机,血管内经皮卵圆孔未闭关闭,(AMPLATZER设备或STARFlex®)和医疗抗凝治疗。主要疗效终点是tissue-defined复发性缺血性中风。Addictional疗效端点是研究定义周期性TIA和死于任何原因。结果:共有三个试验包括2303名患者。关闭我(909名患者),尊重(980名患者),PC-Trial(414名患者)。 For the tissue-defined recurrent ischemic stroke, event rates tended to be lower with closure devices (OR 0.61 [0.35-1.04], p=0.07). Importantly, heterogeneity of effect among devices was found (Isq=54.5%), with benefit seen with use of the Amplatzer PFO occluder (OR 0.42 [0.20-0.88], p=0.02) For the secondary efficacy endpoints, nominal group differences did not reach statistical significance: study-defined recurrent ischemic stroke, OR 0.60 [0.28, 1.27],P=0.18; TIA, OR 0.94 [0.53, 1.65], P=0.82; death from any cause, OR 0.65 [0.23, 1.85],P = 0.42. In subgroup analysis we found that PFO closure was beneficial in patients with a substantial shunt size OR (0.32 [0.11- 0.91] 95% CI; P 0.03) CONCLUSIONS: This meta-analysis found benefit of PFO closure with the Amplatzer PFO Occluder in reducing tissue-defined recurrent ischemic stroke, but no statistically significant benefit in reducing TIA, study-defined ischemic stroke, or all-cause death.

披露:Latini博士没有披露。节省博士已经收到个人活动与加州大学的补偿BrainsGate, CoAxia, ev3, Talecris, PhotoThera Sygnis, Stryker。节省博士已经收到了来自加州大学的研究支持和美国国立卫生研究院。