Adults with congenital heart disease have similar mortality (HR 1.29, 95% CI: 1.0-1.7) and recurrent AMI risk as controls up to 10 years post-first AMI.
Does the presence of adult congenital heart disease affect all-cause mortality and recurrent AMI in patients experiencing their first acute myocardial infarction?
Adults with congenital heart disease who experience a first acute myocardial infarction have similar long-term survival and recurrent AMI rates compared to matched controls without congenital heart disease, despite presenting with AMI on average 12 years earlier.
Tasa de eventos absoluta: 0% vs 0%
Abstract Background The life expectancy of adults with congenital heart disease (ACHD) has improved, thus the focus is shifting towards age-related comorbidities and acquired heart disease in ACHD. Objective The aim of this study was to investigate all-cause mortality and recurrent acute myocardial infarction (AMI) in adults with and without congenital heart defects (CHD) experiencing AMI. Methods We conducted a nationwide analysis using the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART). This registry covers admissions to all cardiovascular care units in Sweden. For this study, SWEDEHEART was used to include all patients aged ≥18 years with AMI between 1 January 2000 and 2 February 2022. The CHD diagnoses and their treatment were retrieved from the SWEDish national registry for CONgenital heart disease (SWEDCON). Each ACHD patient was matched in age and sex with 10 patients without CHD for a cox regression analysis of mortality and recurrent AMI hazard ratios. Results We studied 222 ACHD patients and 281,570 controls who had a first-time AMI. ACHD patients experienced their first AMI on average 12 years earlier than controls (Table 1). The mean follow-up time was 6.5 and 7.3 years for ACHD patients and controls, respectively. During follow-up, 69 (31%) ACHD patients and 132,512 (47%) controls died. Recurrent AMI occurred in 21 (9%) CHD patients and 34,605 (12%) controls. The mortality hazard ratio (HR) was not statistically significant at 180 days (HR 1.06, 95% CI: 0.6–1.9), 1 year (HR 0.97, 95% CI: 0.6–1.7), or 10 years (HR 1.29, 95% CI: 1.0–1.7) after the first AMI. Similarly, the HR for recurrent AMI was not significant at 180 days (HR 0.50, 95% CI: 0.1–2.1), 1 year (HR 0.36, 95% CI: 0.1–1.5), or 10 years (HR 0.85, 95% CI: 0.5–1.4) of follow-up (Figure 1). Both groups presented similar symptoms; however, right bundle branch block (RBBB) was more common in CHD patients (p-value 0.05). Non-CHD patients had a higher burden of significant stenosis on angiography (p-value 0.05). Conclusions This study suggests that survival rates and the incidence of recurrent AMI are similar in ACHD patients and controls but more research is needed. Cardiologists and general practitioners should take this into account when they assess ACHD patients who had an AMI.Figure 1 Table 1
Holmgren et al. (Sat,) reported a other. Adults with congenital heart disease have similar mortality (HR 1.29, 95% CI: 1.0-1.7) and recurrent AMI risk as controls up to 10 years post-first AMI.