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. 2021 Jul 8;42(26):2577-2586.
doi: 10.1093/eurheartj/ehaa874.

Long-term outcomes after myocardial infarction in middle-aged and older patients with congenital heart disease-a nationwide study

Maria Fedchenko  1 , Zacharias Mandalenakis  1   2 , Kok Wai Giang  1 , Annika Rosengren  1 , Peter Eriksson  1   2 , Mikael Dellborg  1   2
Affiliations

Long-term outcomes after myocardial infarction in middle-aged and older patients with congenital heart disease-a nationwide study

Maria Fedchenko et al. Eur Heart J. .

Abstract

Aims: We aimed to describe the risk of myocardial infarction (MI) in middle-aged and older patients with congenital heart disease (ACHD) and to evaluate the long-term outcomes after index MI in patients with ACHD compared with controls.

Methods and results: A search of the Swedish National Patient Register identified 17 189 patients with ACHD (52.2% male) and 180 131 age- and sex-matched controls randomly selected from the general population who were born from 1930 to 1970 and were alive at 40 years of age; all followed up until December 2017 (mean follow-up 23.2 ± 11.0 years). Patients with ACHD had a 1.6-fold higher risk of MI compared with controls [hazard ratio (HR) 1.6, 95% confidence interval (CI) 1.5-1.7, P < 0.001] and the cumulative incidence of MI by 65 years of age was 7.4% in patients with ACHD vs. 4.4% in controls. Patients with ACHD had a 1.4-fold increased risk of experiencing a composite event after the index MI compared with controls (HR 1.4, 95% CI 1.3-1.6, P < 0.001), driven largely by the occurrence of new-onset heart failure in 42.2% (n = 537) of patients with ACHD vs. 29.5% (n = 2526) of controls.

Conclusion: Patients with ACHD had an increased risk of developing MI and of recurrent MI, new-onset heart failure, or death after the index MI, compared with controls, mainly because of a higher incidence of newly diagnosed heart failure in patients with ACHD. Recognizing and managing the modifiable cardiovascular risk factors should be of importance to reduce morbidity and mortality in patients with ACHD.

Keywords: Cardiovascular risk factors; Congenital heart disease; Heart failure; Mortality; Myocardial infarction.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Cumulative incidence of index myocardial infarction in patients with congenital heart disease and controls ≥40 years of age. ACHD, adult congenital heart disease; MI, myocardial infarction.
Figure 2
Figure 2
Kaplan–Meier curve illustrating freedom from composite event (recurrent myocardial infarction, new-onset heart failure, cardiovascular disease mortality) after index myocardial infarction in patients with adult congenital heart disease and controls. ACHD, adult congenital heart disease; MI, myocardial infarction.
Figure 3
Figure 3
Total number of events after index myocardial infarction in patients with adult congenital heart disease and controls. Total number of events included all registered episodes of recurrent myocardial infarction (including fatal myocardial infarctions), hospitalizations or outpatient visits for heart failure, as well as fatal heart failure events in patients with new-onset heart failure. ACHD, adult congenital heart disease; MI, myocardial infarction.
Take home figure
Take home figure
Long-term outcomes after myocardial infarction in middle-aged and older patients with congenital heart disease. ACHD, adult congenital heart disease; MI, myocardial infarction.
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References

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