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Percutaneous atrial shunt closure and the risk of recurrent ischemic stroke: A register-based, nationwide cohort
Alexia Karagianni1, Zacharias Mandalenakis1, Savvas Papadopoulos2
1Center for Adults with Congenital Heart Disease (ACHD), Sahlgrenska University Hospital/Östra, Sweden; Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, Gothenburg University, Sweden.
Insights
Transcatheter closure of atrial shunts (ASCIos) did not reduce recurrent stroke risk compared to medical treatment (ASMed). ASCIos patients faced a nearly tenfold higher risk of stroke than controls without prior events.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Medical Device Technology
Background:
- Atrial shunts are associated with an increased risk of cerebrovascular events (CVEs).
- Transcatheter closure is a treatment option for atrial shunts, but its impact on recurrent stroke risk is not fully established.
- Understanding stroke risk in patients with atrial shunts is crucial for effective management.
Purpose of the Study:
- To compare the risk of recurrent stroke in patients undergoing transcatheter closure of an atrial shunt (ASCIos) versus those medically treated (ASMed).
- To evaluate the stroke risk in ASCIos patients against age- and sex-matched controls without a history of CVE.
Main Methods:
- A nationwide cohort study using the Swedish National Patient Register (1997-2016).
- Propensity score matching was used to compare 663 ASCIos patients with 663 ASMed patients.
- 6,302 controls without atrial shunts or prior CVEs were randomly selected for comparison.
Main Results:
- The incidence rate of recurrent stroke was 0.9 per 100 patient-years in the ASCIos group versus 0.7 per 100 patient-years in the ASMed group.
- The hazard ratio for recurrent stroke in ASCIos patients compared to controls was 9.9 (95% CI, 5.5-17.9).
- Atrial fibrillation incidence was similar between ASCIos and ASMed groups but four times higher in ASCIos than controls.
Conclusions:
- Transcatheter closure of atrial shunts did not reduce the risk of recurrent stroke compared to medical management.
- Patients with atrial shunts, even after closure, have a significantly higher risk of stroke compared to the general population.
- Further research is needed to optimize stroke prevention strategies in patients with atrial shunts.
Objectives:
We aimed to investigate the risk of recurrent stroke in patients with transcatheter closure of an atrial shunt (ASCIos), compared to patients with an atrial shunt and cerebrovascular event (CVE) but only medical treated (ASMed), and to age- and sex-matched control individuals without a previous CVE.
Methods:
In total, 663 ASCIos patients were identified in the Swedish National Patient Register from 1997 to 2016 and matched by using propensity score with 663 ASMed patients. Nine age- and sex-matched controls to ASCIos patients (n = 6,302) without a diagnosis of atrial shunt or history of CVE were randomly selected from the general population.
Results:
At a mean follow-up of 6.5 years, the incidence rate of recurrent stroke in the ASCIos group vs ASMed group was 0.9 vs 0.7 per 100 patient-years. The hazard ratio of recurrent stroke in the ASCIos group compared with index stroke in the control group was 9.9 (95% confidence interval, 5.5-17.9). The incidence of atrial fibrillation was similar in the ASCIos and the ASMed group, however four times higher in the ASCIos than in the control group.
Conclusions:
Our large nationwide, register-based cohort study showed that, unexpectedly, the risk of recurrent stroke in the ASCos group was as high as in the ASMed group and almost ten times higher than the risk of an index stroke in matched controls without previous stroke.
