ABSTRACT NUMBER: ESOC2026A1692 IS AGE A PROGNOSTIC OR PREDICTIVE FACTOR? A STUDY-LEVEL AND KAPLAN–MEIER–DERIVED INDIVIDUAL PATIENT DATA META-ANALYSIS OF PFO CLOSURE IN ADULTS AGED ≥60 YEARS

Abstract Background and aims Older adults (≥60 years) have a higher prevalence of patent foramen ovale (PFO) and may face a greater risk of recurrent stroke, but the benefits and risks of PFO closure in this group remain unclear due to limited trial data. Methods We systematically searched databases for studies of PFO closure (PFOC) in older adults. Outcomes were reported as incidence rates per 100person-years (100-PY) and compared between PFOC and MT, and between older and younger patients. Random-effects meta-analyses were conducted, and time-to-event data reconstructed from Kaplan–Meier curves were used to compare recurrent stroke after PFOC vs MT in elderly. Results Fifteen studies (27,946 patients) were included. Among elderly, recurrent stroke/TIA occurred at 1.55 (95%CI, 1.31–1.82) per 100-PY after PFOC and 3.08 (2.20–4.33) per 100-PY with MT. New-onset AF occurred at 2.55 (2.03–3.21) and 2.08 (1.73–2.50) per 100-PY, respectively. In direct comparisons, PFOC reduced recurrent stroke/TIA and mortality vs MT without increasing AF. Time-to-event analysis showed lower recurrent stroke with PFOC through 4 years (HR=0.66; 95%CI, 0.57–0.75). Compared with younger patients undergoing PFOC, elderly had higher risks of recurrent stroke/TIA, mortality, and AF. Conclusions In older adults, PFOC reduced recurrent cerebrovascular events and mortality compared with MT, without increasing the risk of AF; however, the benefits were smaller than in younger individuals. Older age appeared to be a prognostic factor for higher absolute risk, irrespective of treatment, but not a predictive factor that reduced the relative effectiveness of closure. Conflict of interest All authors report no disclosures.