An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke.

Abstract:

OBJECTIVE:We aimed to create an index to stratify cryptogenic stroke (CS) patients with patent foramen ovale (PFO) by their likelihood that the stroke was related to their PFO. METHODS:Using data from 12 component studies, we used generalized linear mixed models to predict the presence of PFO among patients with CS, and derive a simple index to stratify patients with CS. We estimated the stratum-specific PFO-attributable fraction and stratum-specific stroke/TIA recurrence rates. RESULTS:Variables associated with a PFO in CS patients included younger age, the presence of a cortical stroke on neuroimaging, and the absence of these factors: diabetes, hypertension, smoking, and prior stroke or TIA. The 10-point Risk of Paradoxical Embolism score is calculated from these variables so that the youngest patients with superficial strokes and without vascular risk factors have the highest score. PFO prevalence increased from 23% (95% confidence interval [CI]: 19%-26%) in those with 0 to 3 points to 73% (95% CI: 66%-79%) in those with 9 or 10 points, corresponding to attributable fraction estimates of approximately 0% to 90%. Kaplan-Meier estimated stroke/TIA 2-year recurrence rates decreased from 20% (95% CI: 12%-28%) in the lowest Risk of Paradoxical Embolism score stratum to 2% (95% CI: 0%-4%) in the highest. CONCLUSION:Clinical characteristics identify CS patients who vary markedly in PFO prevalence, reflecting clinically important variation in the probability that a discovered PFO is likely to be stroke-related vs incidental. Patients in strata more likely to have stroke-related PFOs have lower recurrence risk.

journal_name

Neurology

journal_title

Neurology

authors

Kent DM,Ruthazer R,Weimar C,Mas JL,Serena J,Homma S,Di Angelantonio E,Di Tullio MR,Lutz JS,Elkind MS,Griffith J,Jaigobin C,Mattle HP,Michel P,Mono ML,Nedeltchev K,Papetti F,Thaler DE

doi

10.1212/WNL.0b013e3182a08d59

subject

Has Abstract

pub_date

2013-08-13 00:00:00

pages

619-25

issue

7

eissn

0028-3878

issn

1526-632X

pii

WNL.0b013e3182a08d59

journal_volume

81

pub_type

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