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Patent foramen ovale closure vs. medical therapy for recurrent stroke prevention: Evolution of treatment effect during follow-up.

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cris.virtualsource.author-orcidb83848b4-8f34-4f09-bf3b-e39d366ea8e8
cris.virtualsource.author-orcid31134751-5aa4-429b-82a9-a4f94bac9190
cris.virtualsource.author-orcid987e86fe-121f-4490-8444-9a22622c19f7
cris.virtualsource.author-orcid5c8247bd-3b6a-428b-a426-5f9725e9e9a4
cris.virtualsource.author-orcidb7cda86d-8924-42a5-973a-d73fee5c630b
cris.virtualsource.author-orcidb620722a-f94f-4ba9-b338-16a38af6d7d0
cris.virtualsource.author-orcid101f1394-72d5-4dda-b28f-666a3dee6c70
dc.contributor.authorPiccolo, Raffaele
dc.contributor.authorStortecky, Stefan
dc.contributor.authorFranzone, Anna
dc.contributor.authorSiontis, Georgios
dc.contributor.authorPilgrim, Thomas
dc.contributor.authorMeier, Bernhard
dc.contributor.authorWindecker, Stephan
dc.date.accessioned2024-10-08T15:10:50Z
dc.date.available2024-10-08T15:10:50Z
dc.date.issued2018-03-15
dc.description.abstractBACKGROUND Little is known regarding changes in treatment effect over time associated with patent foramen ovale (PFO) closure among patients with embolic stroke of unknown origin. METHODS We reconstructed Kaplan-Meier curves for stroke from individual randomized trials comparing PFO closure vs. medical therapy among patients with embolic stroke. Random effects Cox-regression analyses were performed in order to estimate hazard ratios (HRs) with 95% confidence intervals (95%CIs). RESULTS A total of 2531 patients enrolled across 4 randomized trials were included. PFO closure was associated with a significant reduction in the risk of stroke at longest available follow-up (HR 0.18, 95%CI 0.06 to 0.59, P=0.005). However, recurrent stroke was already significantly reduced among patients randomized to PFO closure at 1-year (HR 0.40, 95%CI 0.20 to 0.80, P=0.010), with the treatment effect remaining consistent (P-for-interaction=0.356) between 1- and 5-year (HR 0.14, 95%CI 0.05 to 0.55, P=0.005) and beyond 5-year (HR 0.20, 95%CI 0.03 to 1.19, P=0.077). CONCLUSIONS Among patients with embolic stroke of unknown origin, PFO closure reduces the risk of stroke compared with medical therapy, with a significant reduction in recurrences starting already within 1-year after percutaneous PFO closure.
dc.description.numberOfPages3
dc.description.sponsorshipUniversitätsklinik für Kardiologie
dc.description.sponsorshipEmeriti, Medizinische Fakultät
dc.identifier.doi10.7892/boris.125247
dc.identifier.pmid29338916
dc.identifier.publisherDOI10.1016/j.ijcard.2018.01.001
dc.identifier.urihttps://boris-portal.unibe.ch/handle/20.500.12422/63307
dc.language.isoen
dc.publisherElsevier
dc.relation.ispartofInternational journal of cardiology
dc.relation.issn0167-5273
dc.relation.organizationDCD5A442BB15E17DE0405C82790C4DE2
dc.subjectEmbolic stroke Meta-analysis Patent foramen ovale
dc.subject.ddc600 - Technology::610 - Medicine & health
dc.titlePatent foramen ovale closure vs. medical therapy for recurrent stroke prevention: Evolution of treatment effect during follow-up.
dc.typearticle
dspace.entity.typePublication
dspace.file.typetext
oaire.citation.endPage31
oaire.citation.startPage29
oaire.citation.volume255
oairecerif.author.affiliationUniversitätsklinik für Kardiologie
oairecerif.author.affiliationUniversitätsklinik für Kardiologie
oairecerif.author.affiliationUniversitätsklinik für Kardiologie
oairecerif.author.affiliationUniversitätsklinik für Kardiologie
oairecerif.author.affiliationUniversitätsklinik für Kardiologie
oairecerif.author.affiliationEmeriti, Medizinische Fakultät
oairecerif.author.affiliationUniversitätsklinik für Kardiologie
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unibe.contributor.rolecreator
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unibe.date.licenseChanged2019-10-23 06:08:48
unibe.description.ispublishedpub
unibe.eprints.legacyId125247
unibe.journal.abbrevTitleINT J CARDIOL
unibe.refereedTRUE
unibe.subtype.articlejournal

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