Sex Differences in Patients With Cryptogenic Cerebrovascular Events Undergoing Transcatheter Closure of Patent Foramen Ovale

Abstract

Background Scarce data exist on sex differences in patients with cryptogenic cerebrovascular events undergoing patent foramen ovale (PFO) closure. This study aimed to determine the sex differences in clinical profile, procedural characteristics, and long‐term outcomes of patients with cryptogenic cerebrovascular events undergoing PFO closure. Methods and Results A retrospective cohort was used, including 1076 consecutive patients undergoing PFO closure because of a cryptogenic cerebrovascular event. Patients were divided into 2 groups: 469 (43.6%) women and 607 (56.4%) men. The median follow‐up was 3 years (interquartile range, 2–8 years). Women were younger (46±13 versus 50±12 years; P <0.01) and had a higher risk of paradoxical embolism score (6.9±1.7 versus 6.6±1.6; P <0.01). Procedural characteristics and postprocedural antithrombotic therapy were similar. At follow‐up, there were no differences in atrial fibrillation (women versus men: 0.47 versus 0.97 per 100 patient‐years; incidence rate ratio [IRR], 0.55 [95% CI, 0.27–1.11]; P =0.095; adjusted P =0.901), stroke (0.17 versus 0.07 per 100 patient‐years; IRR, 2.58 [95% CI, 0.47–14.1]; P =0.274; adjusted P =0.201), or transient ischemic attack (0.43 versus 0.18 per 100 patient‐years; IRR, 2.58 [95% CI, 0.88–7.54]; P =0.084; adjusted P =0.121); nevertheless, women exhibited a higher incidence of combined ischemic cerebrovascular events (0.61 versus 0.26 per 100 patient‐years; IRR, 2.58 [95% CI, 1.04–6.39]; P =0.041; adjusted P =0.028) and bleeding events (1.04 versus 0.45 per 100 patient‐years; IRR, 2.82 [95% CI, 1.41–5.65]; P =0.003; adjusted P =0.004). Conclusions Compared with men, women with cryptogenic cerebrovascular events undergoing PFO closure were younger and had a higher risk of paradoxical embolism score. After a median follow‐up of 3 years, there were no differences in stroke events, but women exhibited a higher rate of combined (stroke and transient ischemic attack) cerebrovascular events and bleeding complications. Additional studies are warranted to clarify sex‐related outcomes after PFO closure further.

Cryptogenic Stroke and PFO Closure: Does Sex Matter?

“…In this issue of the Journal of the American Heart Association ( JAHA ), Farjat‐Pasos et al 14 describe a retrospective cohort of consecutive patients presenting to 2 university hospitals with cryptogenic strokes or transient ischemic attacks (TIAs) who had transcatheter PFO closure performed after a thorough diagnostic workup for other stroke causes. The 1076 patients were then followed for a median of 3 years for follow‐up cerebrovascular and bleeding events.…”