TY - JOUR
T1 - Cardiovascular morbidity and mortality in adult patients with repaired aortic coarctation
AU - Meijs, Timion A.
AU - Minderhoud, Savine C.S.
AU - Muller, Steven A.
AU - de Winter, Robbert J.
AU - Mulder, Barbara J.M.
AU - van Melle, Joost P.
AU - Hoendermis, Elke S.
AU - van Dijk, Arie P.J.
AU - Zuithoff, Nicolaas P.A.
AU - Krings, Gregor J.
AU - Doevendans, Pieter A.
AU - Witsenburg, Maarten
AU - Roos-Hesselink, Jolien W.
AU - van den Bosch, Annemien E.
AU - Bouma, Berto J.
AU - Voskuil, Michiel
N1 - Publisher Copyright: © 2021 The Authors.
PY - 2021/11/16
Y1 - 2021/11/16
N2 - BACKGROUND: The long-term burden of cardiovascular disease after repair of coarctation of the aorta (CoA) has not been eluci-dated. 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, en-docarditis, 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.
AB - BACKGROUND: The long-term burden of cardiovascular disease after repair of coarctation of the aorta (CoA) has not been eluci-dated. 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, en-docarditis, 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.
KW - Adult congenital heart disease
KW - Aortic coarctation
KW - Cardiovascular events
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=85120780439&partnerID=8YFLogxK
U2 - https://doi.org/10.1161/JAHA.121.023199
DO - https://doi.org/10.1161/JAHA.121.023199
M3 - Article
C2 - 34755532
SN - 2047-9980
VL - 10
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 22
M1 - e023199
ER -