Department of Public Health and Clinical Medicine Umeå University Umeå Sweden.
Department of Surgery and Perioperative Sciences Umeå University Umeå Sweden.
J Am Heart Assoc. 2024 Oct;13(19):e034206. doi: 10.1161/JAHA.124.034206. Epub 2024 Sep 18.
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.
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%.
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.
随着越来越多的先天性心脏病患者进入成年期，预计会出现包括缺血性卒中在内的长期并发症的发生率增加。本研究旨在分析成人先天性心脏病患者缺血性卒中的累积发生率、相关因素和病死率。
本研究基于瑞典先天性心脏病和卒中国家登记处的数据。2001 年至 2018 年期间，对患有先天性心脏病的患者进行了随访，以观察首次发生的缺血性卒中事件（排除卵圆孔未闭引起的缺血性卒中）。使用 Cox 回归模型分析了可能与缺血性卒中相关的因素。在 8914 名患有先天性心脏病的成年患者中，有 108 名患者在平均 7.6±4.7 年期间发生了缺血性卒中。缺血性卒中的平均年龄为 53.8 岁，1 年、5 年和 10 年的累积发生率分别为 0.15%、0.5%和 1.5%。多变量分析显示，年龄（风险比[HR]，1.04[95%CI，1.03-1.06]）、糖尿病（HR，2.9[95%CI，1.3-6.4]）、射血分数<50%（HR，1.9[95%CI，1.1-3.4]）、房间隔缺损（HR，3.0[95%CI，1.03-8.5]）和主动脉瓣病变（HR，4.8[95%CI，1.6-14.1]）与缺血性卒中风险增加相关。在发生缺血性卒中的患者中，约有一半在入院前接受了抗血栓治疗（抗凝或抗血小板）。病死率为 6.5%。
10 年后，缺血性卒中的累积发生率为 1.5%。在成人先天性心脏病中，心脏病变类型、糖尿病、射血分数<50%和年龄是与缺血性卒中相关的重要因素。尽管年龄相对较轻，但死亡率是一个严重的威胁。在发生缺血性卒中事件时，大约有一半的患者正在接受抗血栓治疗。
