Evidence map›Paper›PMID 30020431›Full record

Observational studyEuropean heart journal2019

Patent foramen ovale and long-term risk of ischaemic stroke after surgery.

Sabine Friedrich, Pauline Y Ng, Katharina Platzbecker, Sara M Burns, Valerie Banner-Goodspeed, Christian Weimar, Balachundhar Subramaniam, Timothy T Houle, Deepak L Bhatt, Matthias Eikermann

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in European heart journal, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Article
  4. Article
  5. Article
  6. Every Patent Foramen Ovale Should Be Closed.Journal of clinical medicine · 2024
    Review
  7. Article
  8. Review
  9. Article
  10. Patent Foramen Ovale Closure: State of the Art.Interventional cardiology (London, England) · 2020
    Review
  11. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors.

Sabine FriedrichDepartment of Anaesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, 330 Brookline Avenue, Boston, MA, USA.
Pauline Y NgDepartment of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA.
Katharina PlatzbeckerDepartment of Anaesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, 330 Brookline Avenue, Boston, MA, USA.
Sara M BurnsDepartment of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA.
Valerie Banner-GoodspeedDepartment of Anaesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, 330 Brookline Avenue, Boston, MA, USA.
Christian WeimarDepartment of Neurology, Universitätsklinikum Essen, Hufelandstraße 55, Essen, Germany.
Balachundhar SubramaniamDepartment of Anaesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, 330 Brookline Avenue, Boston, MA, USA.
Timothy T HouleDepartment of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA.
Deepak L BhattBrigham and Women's Hospital Heart & Vascular Centre, Harvard Medical School, 75 Francis Street, Boston, MA, USA.
Matthias EikermannDepartment of Anaesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, 330 Brookline Avenue, Boston, MA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsPre-operatively diagnosed patent foramen ovale (PFO) is associated with an increased risk of ischaemic stroke within 30 days after surgery. This study aimed to assess the PFO-attributable ischaemic stroke risk beyond the perioperative period. METHODS AND

resultsThis observational study of adult patients without history of stroke undergoing non-cardiac surgery with general anaesthesia examined the association of PFO with ischaemic stroke 1 and 2 years after surgery using multivariable logistic regression. Of the 144 563 patients included, a total of 1642 (1.1%) and 2376 (1.6%) ischaemic strokes occurred within 1 and 2 years after surgery, 54 (4.7%) and 76 (6.6%) among patients with PFO, and 1588 (1.1%) and 2300 (1.6%) among patients without PFO, respectively. The odds of ischaemic stroke within 1 and 2 years after surgery were increased in patients with PFO: adjusted odds ratio (aOR) 2.01, 95% confidence interval (CI) 1.51-2.69; P < 0.001 and aOR 2.10, 95% CI 1.64-2.68; P < 0.001, respectively. Among patients who underwent contrast transoesophageal echocardiography, the frequency of PFO was 27%, and the increased stroke risk in patients with PFO was robust (aOR 3.80, 95% CI 1.76-8.23; P = 0.001 for year 1). The PFO-attributable risk was mitigated by post-operative prescription of combination antithrombotic therapy (odds ratio 0.41, 95% CI 0.22-0.75; P for interaction = 0.004).

conclusionPatients with PFO are vulnerable to ischaemic stroke for an extended period of time after surgery. Physicians should consider implementing PFO screening protocols in patients scheduled for major non-cardiac surgery.

Indexed as

AdultAgedBrain IschemiaCase-Control StudiesContrast MediaDrug Therapy, CombinationEchocardiography, TransesophagealEmbolism, ParadoxicalFemaleFibrinolytic AgentsForamen Ovale, PatentHumansMaleMiddle AgedPerioperative PeriodPostoperative CareContrast MediaFibrinolytic AgentsAntithrombotic agentsParadoxical embolismPatent foramen ovaleStrokeSurgery

Identifiers

PMID30020431
PMCPMC6416532

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.