Cardiovascular Morbidity and Mortality in Adult Patients With Repaired Aortic Coarctation
Background The long‐term burden of cardiovascular disease after repair of coarctation of the aorta (CoA) has not been elucidated. We aimed to determine the incidence of and risk factors for cardiovascular events in adult patients with repaired CoA. Additionally, mortality rates were compared between...
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2021
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oai:doaj.org-article:358895a1fe8b490c8e67e73b0bffb48b2021-11-16T10:22:43ZCardiovascular Morbidity and Mortality in Adult Patients With Repaired Aortic Coarctation10.1161/JAHA.121.0231992047-9980https://doaj.org/article/358895a1fe8b490c8e67e73b0bffb48b2021-11-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.121.023199https://doaj.org/toc/2047-9980Background The long‐term burden of cardiovascular disease after repair of coarctation of the aorta (CoA) has not been elucidated. We aimed to determine the incidence of and risk factors for cardiovascular events in adult patients with repaired CoA. Additionally, mortality rates were compared between adults with repaired CoA and the general population. Methods and Results Using the Dutch Congenital Corvitia (CONCOR) registry, patients aged ≥16 years with previous surgical or transcatheter CoA repair from 5 tertiary referral centers were included. Cardiovascular events were recorded, comprising coronary artery disease, stroke/transient ischemic attack, aortic complications, arrhythmias, heart failure hospitalizations, endocarditis, and cardiovascular death. In total, 920 patients (median age, 24 years [range 16–74 years]) were included. After a mean follow‐up of 9.3±5.1 years, 191 patients (21%) experienced at least 1 cardiovascular event. A total of 270 cardiovascular events occurred, of which aortic complications and arrhythmias were most frequent. Older age at initial CoA repair (hazard ratio [HR], 1.017; 95% CI, 1.000–1.033 [P=0.048]) and elevated left ventricular mass index (HR, 1.009; 95% CI, 1.005–1.013 [P<0.001]) were independently associated with an increased risk of cardiovascular events. The mortality rate was 3.3 times higher than expected based on an age‐ and sex‐matched cohort from the Dutch general population (standardized mortality ratio, 3.3; 95% CI, 2.3–4.4 [P<0.001]). Conclusions This large, prospective cohort of adults with repaired CoA showed a high burden of cardiovascular events, particularly aortic complications and arrhythmias, during long‐term follow‐up. Older age at initial CoA repair and elevated left ventricular mass index were independent risk factors for the occurrence of cardiovascular events. Mortality was 3.3‐fold higher compared with the general population. These results advocate stringent follow‐up after CoA repair and emphasize the need for improved preventive strategies.Timion A. MeijsSavine C. S. MinderhoudSteven A. MullerRobbert J. de WinterBarbara J. M. MulderJoost P. van MelleElke S. HoendermisArie P. J. van DijkNicolaas P. A. ZuithoffGregor J. KringsPieter A. DoevendansMaarten WitsenburgJolien W. Roos‐HesselinkAnnemien E. van den BoschBerto J. BoumaMichiel VoskuilWileyarticleadult congenital heart diseaseaortic coarctationcardiovascular eventssurvivalDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 22 (2021) |
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DOAJ |
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EN |
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adult congenital heart disease aortic coarctation cardiovascular events survival Diseases of the circulatory (Cardiovascular) system RC666-701 |
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adult congenital heart disease aortic coarctation cardiovascular events survival Diseases of the circulatory (Cardiovascular) system RC666-701 Timion A. Meijs Savine C. S. Minderhoud Steven A. Muller Robbert J. de Winter Barbara J. M. Mulder Joost P. van Melle Elke S. Hoendermis Arie P. J. van Dijk Nicolaas P. A. Zuithoff Gregor J. Krings Pieter A. Doevendans Maarten Witsenburg Jolien W. Roos‐Hesselink Annemien E. van den Bosch Berto J. Bouma Michiel Voskuil Cardiovascular Morbidity and Mortality in Adult Patients With Repaired Aortic Coarctation |
| description |
Background The long‐term burden of cardiovascular disease after repair of coarctation of the aorta (CoA) has not been elucidated. We aimed to determine the incidence of and risk factors for cardiovascular events in adult patients with repaired CoA. Additionally, mortality rates were compared between adults with repaired CoA and the general population. Methods and Results Using the Dutch Congenital Corvitia (CONCOR) registry, patients aged ≥16 years with previous surgical or transcatheter CoA repair from 5 tertiary referral centers were included. Cardiovascular events were recorded, comprising coronary artery disease, stroke/transient ischemic attack, aortic complications, arrhythmias, heart failure hospitalizations, endocarditis, and cardiovascular death. In total, 920 patients (median age, 24 years [range 16–74 years]) were included. After a mean follow‐up of 9.3±5.1 years, 191 patients (21%) experienced at least 1 cardiovascular event. A total of 270 cardiovascular events occurred, of which aortic complications and arrhythmias were most frequent. Older age at initial CoA repair (hazard ratio [HR], 1.017; 95% CI, 1.000–1.033 [P=0.048]) and elevated left ventricular mass index (HR, 1.009; 95% CI, 1.005–1.013 [P<0.001]) were independently associated with an increased risk of cardiovascular events. The mortality rate was 3.3 times higher than expected based on an age‐ and sex‐matched cohort from the Dutch general population (standardized mortality ratio, 3.3; 95% CI, 2.3–4.4 [P<0.001]). Conclusions This large, prospective cohort of adults with repaired CoA showed a high burden of cardiovascular events, particularly aortic complications and arrhythmias, during long‐term follow‐up. Older age at initial CoA repair and elevated left ventricular mass index were independent risk factors for the occurrence of cardiovascular events. Mortality was 3.3‐fold higher compared with the general population. These results advocate stringent follow‐up after CoA repair and emphasize the need for improved preventive strategies. |
| format |
article |
| author |
Timion A. Meijs Savine C. S. Minderhoud Steven A. Muller Robbert J. de Winter Barbara J. M. Mulder Joost P. van Melle Elke S. Hoendermis Arie P. J. van Dijk Nicolaas P. A. Zuithoff Gregor J. Krings Pieter A. Doevendans Maarten Witsenburg Jolien W. Roos‐Hesselink Annemien E. van den Bosch Berto J. Bouma Michiel Voskuil |
| author_facet |
Timion A. Meijs Savine C. S. Minderhoud Steven A. Muller Robbert J. de Winter Barbara J. M. Mulder Joost P. van Melle Elke S. Hoendermis Arie P. J. van Dijk Nicolaas P. A. Zuithoff Gregor J. Krings Pieter A. Doevendans Maarten Witsenburg Jolien W. Roos‐Hesselink Annemien E. van den Bosch Berto J. Bouma Michiel Voskuil |
| author_sort |
Timion A. Meijs |
| title |
Cardiovascular Morbidity and Mortality in Adult Patients With Repaired Aortic Coarctation |
| title_short |
Cardiovascular Morbidity and Mortality in Adult Patients With Repaired Aortic Coarctation |
| title_full |
Cardiovascular Morbidity and Mortality in Adult Patients With Repaired Aortic Coarctation |
| title_fullStr |
Cardiovascular Morbidity and Mortality in Adult Patients With Repaired Aortic Coarctation |
| title_full_unstemmed |
Cardiovascular Morbidity and Mortality in Adult Patients With Repaired Aortic Coarctation |
| title_sort |
cardiovascular morbidity and mortality in adult patients with repaired aortic coarctation |
| publisher |
Wiley |
| publishDate |
2021 |
| url |
https://doaj.org/article/358895a1fe8b490c8e67e73b0bffb48b |
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