Background Patent foramen ovale and atrial septal aneurysm havebeen identified as potential risk factors for stroke, but informationabout their effect on the risk of recurrent stroke is limited.We studied the risks of recurrent cerebrovascular events associatedwith these cardiac abnormalities.
Methods A total of 581 patients (age, 18 to 55 years) who hadhad an ischemic stroke of unknown origin within the precedingthree months were consecutively enrolled at 30 neurology departments.All patients received aspirin (300 mg per day) for secondaryprevention.
Results After four years, the risk of recurrent stroke was 2.3percent (95 percent confidence interval, 0.3 to 4.3 percent)among the patients with patent foramen ovale alone, 15.2 percent(95 percent confidence interval, 1.8 to 28.6 percent) amongthe patients with both patent foramen ovale and atrial septalaneurysm, and 4.2 percent (95 percent confidence interval, 1.8to 6.6 percent) among the patients with neither of these cardiacabnormalities. There were no recurrences among the patientswith an atrial septal aneurysm alone. The presence of both cardiacabnormalities was a significant predictor of an increased riskof recurrent stroke (hazard ratio for the comparison with theabsence of these abnormalities, 4.17; 95 percent confidenceinterval, 1.47 to 11.84), whereas isolated patent foramen ovale,whether small or large, was not.
Conclusions Patients with both patent foramen ovale and atrialseptal aneurysm who have had a stroke constitute a subgroupat substantial risk for recurrent stroke, and preventive strategiesother than aspirin should be considered.
Source Information
From the Department of Neurology, Sainte-Anne Hospital, Paris V University, Paris (J.-L.M., C.A., C.L., M.Z.); the Departments of Cardiology (L.C.) and Biostatistics (J.C.), Cochin Hospital, Paris V University, Paris; and the Department of Cardiology, Charles Nicolle Hospital, Rouen University, Rouen, France (G.D.).
Address reprint requests to Dr. Mas at the Service de Neurologie, Hôpital Sainte-Anne, 1 rue Cabanis, 75674 Paris CEDEX 14, France, or at mas{at}chsa.broca.inserm.fr.
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