Effectiveness of PFO Closure in Preventing Cerebrovascular Events: A 13‐Year Retrospective Cohort Study

ABSTRACT Background The association between patent foramen ovale (PFO) and cerebrovascular events and major adverse cardiovascular events (MACE) is less explored. Aims This study evaluates the effectiveness of PFO closure versus non‐closure on the risk of MACE and cerebrovascular events in patients with or without a CVA history. Methods This retrospective cohort study included patients diagnosed with PFO who were younger than 60 years old and referred to the Professor Kojuri Cardiovascular Clinic between 2010 and 2023. Patients were interviewed for the occurrence of MACEs post‐diagnosis or closure. The MACE components consisted of myocardial infarction (MI), cerebrovascular accidents or transient ischemic attacks (CVA/TIA), decompensated heart failure (DHF), and cardiac death. Results Among 122 participants with prior CVA, MACE incidence was seen at 13 (10.6%), including eight new CVAs (6.6%), three new MI events (2.5%), and two new cases of acute DHF (1.6%). No significant differences in MACE incidence rates were found between PFO closure and non‐closure groups ( p = 0.430), nor in new CVA occurrences ( p = 0.479). Among 58 patients without prior CVA, MACE incidence was five (8.6%), including two new MIs (3.4%), two new cases of acute DHF (3.4%), and one new CVA (1.7%). Similarly, no significant differences were observed in MACE rates ( p = 0.192) or new CVA occurrences ( p = 0.328) between closed and non‐closed groups. Conclusion Our findings over a period of 13 years suggest that PFO closure may not provide a clear protective benefit against MACEs in this population, regardless of prior CVA history, highlighting the need for further research to identify specific patient subgroups that might benefit from this intervention.