Key result
Transcatheter atrial shunt closure shows no benefit over medical therapy for recurrent stroke.
Why the study?
The risk of recurrent stroke after transcatheter closure of an atrial shunt compared to medical treatment and controls was unclear.
Does transcatheter closure of an atrial shunt reduce the risk of recurrent ischemic stroke in patients with a previous cerebrovascular event compared to medical therapy alone?
Cohort (n=7,628)
Yes
Does transcatheter closure of an atrial shunt reduce the risk of recurrent ischemic stroke in patients with a previous cerebrovascular event compared to medical therapy alone?
Hazard Ratio: 9.9 (95% CI 5.5–17.9)
Absolute Event Rate: 0.9% vs 0.7%
Transcatheter closure of an atrial shunt did not reduce the risk of recurrent stroke compared to medical therapy alone in patients with a prior cerebrovascular event, challenging expectations for secondary prevention.
Shunt closure was associated with similar recurrent stroke rates; leaves open efficacy in randomized trials of selected patients.
OBJECTIVES: We aimed to investigate the risk of recurrent stroke in patients with transcatheter closure of an atrial shunt (ASCIos), compared to patients with an atrial shunt and cerebrovascular event (CVE) but only medical treated (ASMed), and to age- and sex-matched control individuals without a previous CVE. METHODS: In total, 663 ASCIos patients were identified in the Swedish National Patient Register from 1997 to 2016 and matched by using propensity score with 663 ASMed patients. Nine age- and sex-matched controls to ASCIos patients (n = 6,302) without a diagnosis of atrial shunt or history of CVE were randomly selected from the general population. RESULTS: At a mean follow-up of 6.5 years, the incidence rate of recurrent stroke in the ASCIos group vs ASMed group was 0.9 vs 0.7 per 100 patient-years. The hazard ratio of recurrent stroke in the ASCIos group compared with index stroke in the control group was 9.9 (95% confidence interval, 5.5-17.9). The incidence of atrial fibrillation was similar in the ASCIos and the ASMed group, however four times higher in the ASCIos than in the control group. CONCLUSIONS: Our large nationwide, register-based cohort study showed that, unexpectedly, the risk of recurrent stroke in the ASCos group was as high as in the ASMed group and almost ten times higher than the risk of an index stroke in matched controls without previous stroke.
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Karagianni et al. (2023) conducted a cohort in Atrial shunt and cerebrovascular event (n=7,628). Transcatheter closure of an atrial shunt vs. Medical treatment only and matched controls without previous cerebrovascular event was evaluated on Recurrent stroke (HR 9.9, 95% CI 5.5-17.9). Transcatheter closure of an atrial shunt had a recurrent stroke rate of 0.9 per 100 patient-years, similar to medical therapy (0.7), but higher than controls (HR 9.9; 95% CI 5.5-17.9).
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