Ischemic Stroke in Adults With Congenital Heart Disease: Cumulative Incidence and Associated Factors
Maria Angerbjörn1, Bengt Johansson2, Marie Eriksson3
1Department of Public Health and Clinical Medicine Umeå University Umeå Sweden.
Insights
Adults with congenital heart disease face a 1.5% risk of ischemic stroke within 10 years. Key risk factors include heart lesions, diabetes, reduced ejection fraction, and age, highlighting significant mortality threats.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Growing population of adults with congenital heart disease (CH D) leads to increased long-term complications.
- Ischemic stroke is a significant concern among these long-term complications.
Purpose of the Study:
- To determine the cumulative incidence of ischemic stroke in adults with congenital heart disease.
- To identify factors associated with ischemic stroke in this population.
- To analyze the case fatality rate of ischemic stroke in adults with congenital heart disease.
Main Methods:
- Utilized Swedish national registers for congenital heart disease and stroke data.
- Followed 8914 adult patients with congenital heart disease from 2001 to 2018.
- Excluded ischemic stroke due to patent foramen ovale and analyzed associated factors using Cox regression models.
Main Results:
- 108 out of 8914 patients experienced ischemic stroke over a mean of 7.6 years.
- Cumulative incidence reached 1.5% at 10 years, with a mean age of 53.8 years at stroke onset.
- Associated factors included age, diabetes, ejection fraction <50%, atrial septal defect, and aortic valve lesions. Case fatality was 6.5%.
Conclusions:
- The 10-year cumulative incidence of ischemic stroke in adults with congenital heart disease is 1.5%.
- Heart lesion type, diabetes, reduced ejection fraction, and age are critical risk factors.
- Mortality remains a significant threat, with approximately half of stroke patients on antithrombotic treatment prior to the event.
Background:
When more patients with congenital heart disease reach adult age, increased incidence of long-term complications, including ischemic stroke, are expected. The aim of this study was to analyze cumulative incidence of ischemic stroke, associated factors, and case fatality in adult congenital heart disease.
Methods And Results:
The study is based on Swedish national registers on congenital heart disease and stroke. Patients with congenital heart disease were followed between 2001 and 2018 for first-ever ischemic stroke events (ischemic stroke due to patent foramen ovale excluded). Factors possibly associated with ischemic stroke were analyzed using Cox regression models. Out of 8914 adult patients with congenital heart disease, 108 suffered ischemic stroke over a mean period of 7.6±4.7 years. The mean age at ischemic stroke was 53.8 years, and the cumulative incidence was 0.15% at 1 year, 0.5% at 5 years, and 1.5% at 10 years. In multivariable analysis, age (hazard ratio [HR], 1.04 [95% CI, 1.03-1.06]), diabetes (HR, 2.9 [95% CI, 1.3-6.4]), ejection fraction <50% (HR, 1.9 [95% CI, 1.1-3.4]), atrial septal defect (HR, 3.0 [95% CI, 1.03-8.5]), and aortic valve lesions (HR, 4.8 [95% CI, 1.6-14.1]) were associated with increased risk. Among those with ischemic stroke, approximately half were on antithrombotic treatment (anticoagulants or antiplatelets) before admission. Case fatality was 6.5%.
Conclusions:
The cumulative incidence of ischemic stroke was 1.5% after 10 years. In adult congenital heart disease, the type of heart lesion, diabetes, ejection fraction <50%, and age were important factors associated with ischemic stroke. Despite a relatively young age, mortality is a significant threat. At time of the ischemic stroke event, approximately half of the patients were on antithrombotic treatment.
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