Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://cr.elmerpub.com

Original Article

Volume 16, Number 6, December 2025, pages 499-506

Impact of Patent Foramen Ovale on In-Hospital Outcomes in Acute Pulmonary Embolism

↓ Figure 1. Clinical characteristics, severity of presentation, and in-hospital outcomes of patients admitted with acute pulmonary embolism (PE) and concomitant patent foramen ovale (PFO).

↓ **Table 1.** Clinical Presentation in PE Patients With and Without PFO
	PE only (N = 898,370)	PE with PFO (N = 4,860)	P-value
Values are expressed as mean ± SD for continuous variables or percentages for categorical variables. PE: pulmonary embolism; PFO: patent foramen ovale; SD: standard deviation.
Saddle PE	81,135 (9)	860 (17.7)	< 0.001
Cor pulmonale	74,245 (8.3)	870 (17.9)	< 0.001
Shock	25,560 (2.9)	470 (9.7)	< 0.001
Progressive hypoxia	52,275 (5.8)	700 (14.4)	< 0.001
Pressors	7,385 (0.8)	170 (3.5)	< 0.001
PE with high-risk features	64,525 (7.2)	940 (19.3)	< 0.001

↓ Table 1. Clinical Presentation in PE Patients With and Without PFO

PE only (N = 898,370)

PE with PFO (N = 4,860)

P-value

Values are expressed as mean ± SD for continuous variables or percentages for categorical variables. PE: pulmonary embolism; PFO: patent foramen ovale; SD: standard deviation.

Saddle PE

81,135 (9)

860 (17.7)

< 0.001

Cor pulmonale

74,245 (8.3)

870 (17.9)

< 0.001

Shock

25,560 (2.9)

470 (9.7)

< 0.001

Progressive hypoxia

52,275 (5.8)

700 (14.4)

< 0.001

Pressors

7,385 (0.8)

170 (3.5)

< 0.001

PE with high-risk features

64,525 (7.2)

940 (19.3)

< 0.001

↓ **Table 2.** Advanced Therapies in PE Patients With and Without PFO
	PE only (N = 898,370)	PE with PFO (N = 4,860)	P-value
Values are expressed as mean ± SD for continuous variables or percentages for categorical variables. PE: pulmonary embolism; PFO: patent foramen ovale; SD: standard deviation.
Systemic thrombolysis	22,185 (2.5)	180 (3.7)	0.010
Catheter directed thrombolysis	34,380 (3.8)	360 (7.4)	< 0.001
Catheter directed embolectomy	12,000 (1.3)	210 (4.3)	< 0.001
Surgical embolectomy	1,445 (0.2)	365 (7.5)	< 0.001

↓ Table 2. Advanced Therapies in PE Patients With and Without PFO

PE only (N = 898,370)

PE with PFO (N = 4,860)

P-value

Values are expressed as mean ± SD for continuous variables or percentages for categorical variables. PE: pulmonary embolism; PFO: patent foramen ovale; SD: standard deviation.

Systemic thrombolysis

22,185 (2.5)

180 (3.7)

0.010

Catheter directed thrombolysis

34,380 (3.8)

360 (7.4)

< 0.001

Catheter directed embolectomy

12,000 (1.3)

210 (4.3)

< 0.001

Surgical embolectomy

1,445 (0.2)

365 (7.5)

< 0.001

↓ **Table 3.** In-Hospital Outcomes in PE Patients With and Without PFO
	PE only (N = 898,370)	PE with PFO (N = 4,860)	P-value
Adjusted for demographics, and all comorbidities listed in Table 1. CI: confidence interval; MI: myocardial infarction; OR: odds ratio; PE: pulmonary embolism; PFO: patent foramen ovale.
In-hospital mortality
%	3.1%	5.8%
Unadjusted OR (95% CI)	Ref.	1.8 (1.5 - 2.5)	< 0.001
Adjusted OR (95% CI)	Ref.	0.9 (0.6 - 1.3)	0.702
MI
%	3.6%	1.8%
Unadjusted OR (95% CI)	Ref.	2 (1.4 - 2.9)	< 0.001
Adjusted OR (95% CI)	Ref.	1.6 (1.1 - 2.3)	0.02
Stroke
%	0.5%	13.5%
Unadjusted OR (95% CI)	Ref.	30.4 (25 - 37)	< 0.001
Adjusted OR (95% CI)	Ref.	25.5 (19.8 - 32.8)	< 0.001
Peripheral embolism
%	0.6%	9.6%
Unadjusted OR (95% CI)	Ref.	18.7 (15 - 23.4)	< 0.001
Adjusted OR (95% CI)	Ref.	13.7 (10.5 - 18)	< 0.001
Bleeding
%	9.3%	16.7%
Unadjusted OR (95% CI)	Ref.	1.9 (1.6 - 2.3)	< 0.001
Adjusted OR (95% CI)	Ref.	1.1 (0.9 - 1.3)	0.409

↓ Table 3. In-Hospital Outcomes in PE Patients With and Without PFO

PE only (N = 898,370)

PE with PFO (N = 4,860)

P-value

Adjusted for demographics, and all comorbidities listed in Table 1. CI: confidence interval; MI: myocardial infarction; OR: odds ratio; PE: pulmonary embolism; PFO: patent foramen ovale.

In-hospital mortality

3.1%

5.8%

Unadjusted OR (95% CI)

Ref.

1.8 (1.5 - 2.5)

< 0.001

Adjusted OR (95% CI)

Ref.

0.9 (0.6 - 1.3)

0.702

3.6%

1.8%

Unadjusted OR (95% CI)

Ref.

2 (1.4 - 2.9)

< 0.001

Adjusted OR (95% CI)

Ref.

1.6 (1.1 - 2.3)

0.02

Stroke

0.5%

13.5%

Unadjusted OR (95% CI)

Ref.

30.4 (25 - 37)

< 0.001

Adjusted OR (95% CI)

Ref.

25.5 (19.8 - 32.8)

< 0.001

Peripheral embolism

0.6%

9.6%

Unadjusted OR (95% CI)

Ref.

18.7 (15 - 23.4)

< 0.001

Adjusted OR (95% CI)

Ref.

13.7 (10.5 - 18)

< 0.001

Bleeding

9.3%

16.7%

Unadjusted OR (95% CI)

Ref.

1.9 (1.6 - 2.3)

< 0.001

Adjusted OR (95% CI)

Ref.

1.1 (0.9 - 1.3)

0.409

↓ **Table 4.** Resources Utilization
	PE without PFO	PE with PFO	P-value
^aAdjusted for inflation. Values are expressed as mean ± SD and median (IQR). IQR: interquartile range; LOS: length of stay; PE: pulmonary embolism; PFO: patent foramen ovale; SD: standard deviation.
LOS (days)	4.3 (3.4 - 4.6)	7.4 (6.1 - 8.9)	< 0.001
Total cost^a ($)	12,008 ± 15,116	30,723 ± 57,305	< 0.001
Total charge^a ($)	49,677 ± 70,313	126,355 ± 238,335	< 0.001

↓ Table 4. Resources Utilization

PE without PFO

PE with PFO

P-value

^aAdjusted for inflation. Values are expressed as mean ± SD and median (IQR). IQR: interquartile range; LOS: length of stay; PE: pulmonary embolism; PFO: patent foramen ovale; SD: standard deviation.

LOS (days)

4.3 (3.4 - 4.6)

7.4 (6.1 - 8.9)

< 0.001

Total cost^a ($)

12,008 ± 15,116

30,723 ± 57,305

< 0.001

Total charge^a ($)

49,677 ± 70,313

126,355 ± 238,335

< 0.001