In patients presenting with acute myocardial infarction, treatment with drug-eluting stents is associated with decreased 2-year mortality rates and a reduction in the need for repeat revascularization procedures as compared with treatment with bare-metal stents.

Background-Clinical observations of migraine headache symptoms in patients with a patent foramen ovale (PFO), both of which conditions are highly prevalent, have raised the question of a possible pathophysiological relationship. We sought to evaluate the assumption of an association between migraine headaches and the presence of PFO by use of a large case-control study. Methods and Results-We conducted a case-control study to assess the prevalence of PFO in subjects with and without migraine. Case subjects were those with a history of migraine (diagnosed by neurologists at a specialty academic headache clinic). Control subjects were healthy volunteers without migraine 1:1 matched on the basis of age and sex with case subjects. Presence of PFO was determined by transthoracic echocardiogram with second harmonic imaging and transcranial Doppler ultrasonography during a standardized procedure of infused agitated saline contrast with or without Valsalva maneuver and a review of the results by experts blinded to case-control status. PFO was considered present if both studies were positive. Odds ratios were calculated with conditional logistic regression in the matched cohort (nϭ288). In the matched analysis, the prevalence of PFO was similar in case and control subjects (26.4% versus 25.7%; odds ratio 1.04, 95% confidence interval 0.62 to 1.74, Pϭ0.90). There was no difference in PFO prevalence in those with migraine with aura and those without (26.8% versus 26.1%; odds ratio 1.03, 95% confidence interval 0.48 to 2.21, Pϭ0.93). Conclusions-We found no association between migraine headaches and the presence of PFO in this large case-control study. (Circulation. 2010;121:1406-1412.)Key Words: migraine Ⅲ patent foramen ovale Ⅲ echocardiography Ⅲ epidemiology M igraine headache is a chronic disabling condition that affects approximately 6% of men and 15% to 18% of women. [1][2][3] Its peak prevalence is in midlife, and the condition may result in significant functional impairment and loss of productivity and is associated with high healthcare costs. 1 Migraine headache may be preceded by an aura, a neurological disturbance, most commonly visual or sensory, with subsequent complete recovery. Migraine is thought to be caused by both hereditary and environmental factors and is believed to have neurogenic and neurovascular components to its origin, but its pathophysiology remains incompletely understood. Patent foramen ovale (PFO) is a slitlike interatrial defect that is quite common in the general population, with a prevalence of approximately 10% to 25% depending on the population studied and the methodology used for diagnosis. 4 -7 It occurs with equal frequency in men and women and tends to decrease in frequency with age. Editorial see p 1377 Clinical Perspective on p 1412Observational studies have concluded that a lower frequency of migraine attacks occurred after PFO closure for cryptic stroke, whereas others have postulated a relationship between shunt magnitude and migraine attacks. 8 -16 Thus, a hypothesis has em...

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A small absolute increase in DES thrombosis compared with BMS after 1 year (>0.14%/year) would result in BMS being the preferred strategy for the overall PCI population. Larger clinical trials with longer follow-up are needed to estimate the risk of late stent thrombosis with greater certainty for existing and new DES.