Age matters: comparing outcomes of PFO closure in older vs. younger patients

Abstract Background Patent foramen ovale (PFO) is frequently identified in patients over 60 years old who present with cryptogenic stroke. Whether PFO closure benefits older patients with PFO, and cryptogenic stroke is unknown because randomized controlled trials have predominantly enrolled patients younger than 60 years of age. Aim Our objective was to compare the outcomes of PFO closure in patients over 60 years of age with those under 60 years to evaluate the safety and efficacy of the procedure for both age groups. Methods Medline, Cochrane and Web of Science were systematically searched from inception to December 2024. Only observational studies comparing the efficacy of transcatheter PFO closure between older (60 years old) and younger (60 years old) patients were included. Results A total of twelve studies, comprising 5,909 patients, were included in the analysis. Among them, 2,151 patients were 60 years old, while 3,758 were younger. Over a mean follow-up of 4.32 years, all-cause mortality was significantly higher in older compared to younger patients (OR: 2.647; 95% CI: 1.561 – 4.489; p 0.06). Older group of patients had a significantly increased risk of recurrent ischemic events (OR: 2.453; 95% CI: 1.762–3.417; p 0.001) and developing atrial fibrillation (OR: 2.698; 95% CI: 1.310–5.013; p 0.001). Moreover, older patients had higher risk of presenting residual shunt post-procedurally although this did not reach statistical significance (OR: 1.265; 95% CI: 0.934–1.714; p = 0.129). Egger’s regression test showed no significant publication bias in the meta-analysis. Conclusion This meta-analysis reveals notable differences in outcomes between older and younger patients undergoing transcatheter PFO closure for cryptogenic stroke. Older patients exhibited higher rates of all-cause mortality, recurrent ischemic events, and atrial fibrillation compared to younger individuals. These results underscore the need for careful patient selection and individualized risk assessment when considering PFO closure in older populations. Further randomized clinical trials are needed to clarify the long-term efficacy and safety of PFO closure in older adults.