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Updated: Jan 9, 2026
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Patent foramen ovale is a significant risk factor for patients with coronary artery disease: a long-term follow-up
Bowen Li1,2, Huimin Yan1,2, Xueqiao Yang1,2
1Department of Radiology, Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan, Shandong 250117, China.
Insights
Patent foramen ovale (PFO) increases the risk of major adverse cardiovascular events (MACEs) in patients with coronary artery disease (CAD). This study found PFO is an independent predictor of MACEs in CAD patients.
Area of Science:
- Cardiology
- Cardiovascular Research
- Medical Diagnostics
Background:
- Patent foramen ovale (PFO) is a common cardiac anomaly.
- The link between PFO and major adverse cardiovascular events (MACEs) in patients with coronary artery disease (CAD) requires further clarification.
Purpose of the Study:
- To compare the prognosis of patients with and without PFO.
- To investigate the association between PFO and MACEs in patients diagnosed with CAD.
Main Methods:
- Retrospective analysis of 2667 patients undergoing coronary computed tomography angiography (CCTA).
- MACEs defined as cardiac death, non-fatal myocardial infarction, or ischemic stroke.
- Median follow-up of 86 months.
Main Results:
- Patients with PFO exhibited a significantly higher cumulative incidence of MACEs compared to those without PFO (P<0.001).
- PFO was independently associated with MACEs in CAD patients (HR=2.98, P<0.001).
- Consistent associations were observed for both primary (cardiac death/myocardial infarction) and secondary (ischemic stroke) endpoints.
Conclusions:
- Patent foramen ovale is linked to an adverse prognosis in patients with coronary artery disease.
- PFO presence significantly elevates the risk of MACEs in this patient population.
Aims:
Patent foramen ovale (PFO) is associated with a variety of clinical events; however, its association with major adverse cardiovascular events (MACEs) in patients with coronary artery disease (CAD) remains unclear. The objective of our study was to compare the prognosis between patients with and without PFO and to investigate the association between PFO and MACEs in patients with CAD.
Methods And Results:
This study retrospectively included 2667 patients who underwent coronary computed tomography angiography (CCTA) for the evaluation of suspected CAD. MACEs were defined as cardiac death, non-fatal myocardial infarction, and ischemic stroke. The primary endpoint was a composite of cardiac death and non-fatal myocardial infarction. The secondary endpoint was defined as ischemic stroke. After a median follow-up of 86 months (interquartile range: 74-99 months), 288 patients experienced MACEs, among whom 203 patients had the primary endpoint and 85 patients had the secondary endpoint. Compared with patients without PFO, patients with PFO had a higher cumulative incidence of MACEs (P < 0.001), as well as higher cumulative incidence rates for both the primary endpoint (P < 0.001) and secondary endpoint (P < 0.001). PFO was significantly associated with MACEs in patients with CAD (HR = 3.82, P < 0.001). In multivariate analysis, PFO remained an independent predictor of MACE in patients with CAD (HR = 2.98, P < 0.001), with consistent results observed in the analyses of both the primary endpoint and secondary endpoint (All P < 0.001).
Conclusion:
PFO is associated with adverse prognosis in patients with CAD, and patients with PFO have a higher risk of MACEs.
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