Predictors of stroke recurrence differed by RoPE score, with echocardiographic features and prior stroke/TIA predicting recurrence only in patients with a high RoPE score (>6).
Observational (n=1,324)
Yes
Do predictors of stroke recurrence differ between patients with cryptogenic stroke and PFO who have a high versus low RoPE score?
Predictors of recurrent stroke in patients with cryptogenic stroke and PFO differ significantly based on the RoPE score, suggesting heterogeneous underlying stroke mechanisms that may require tailored management.
OBJECTIVE: To examine predictors of stroke recurrence in patients with a high vs a low likelihood of having an incidental patent foramen ovale (PFO) as defined by the Risk of Paradoxical Embolism (RoPE) score. METHODS: Patients in the RoPE database with cryptogenic stroke (CS) and PFO were classified as having a probable PFO-related stroke (RoPE score of >6, n = 647) and others (RoPE score of ≤6 points, n = 677). We tested 15 clinical, 5 radiologic, and 3 echocardiographic variables for associations with stroke recurrence using Cox survival models with component database as a stratification factor. An interaction with RoPE score was checked for the variables that were significant. RESULTS: Follow-up was available for 92%, 79%, and 57% at 1, 2, and 3 years. Overall, a higher recurrence risk was associated with an index TIA. For all other predictors, effects were significantly different in the 2 RoPE score categories. For the low RoPE score group, but not the high RoPE score group, older age and antiplatelet (vs warfarin) treatment predicted recurrence. Conversely, echocardiographic features (septal hypermobility and a small shunt) and a prior (clinical) stroke/TIA were significant predictors in the high but not low RoPE score group. CONCLUSION: Predictors of recurrence differ when PFO relatedness is classified by the RoPE score, suggesting that patients with CS and PFO form a heterogeneous group with different stroke mechanisms. Echocardiographic features were only associated with recurrence in the high RoPE score group.
Thaler et al. (Mon,) conducted a observational in Cryptogenic stroke and patent foramen ovale (n=1,324). High RoPE score (>6) vs. Low RoPE score (≤6) was evaluated on Stroke recurrence. Predictors of stroke recurrence differed by RoPE score, with echocardiographic features and prior stroke/TIA predicting recurrence only in patients with a high RoPE score (>6).