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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 betwee...

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Autores principales: Meijs, Timion A., Minderhoud, Savine C. S., Muller, Steven A., de Winter, Robbert J., Mulder, Barbara J. M., van Melle, Joost P., Hoendermis, Elke S., van Dijk, Arie P. J., Zuithoff, Nicolaas P. A., Krings, Gregor J., Doevendans, Pieter A., Witsenburg, Maarten, Roos‐Hesselink, Jolien W., van den Bosch, Annemien E., Bouma, Berto J., Voskuil, Michiel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8751912/
https://www.ncbi.nlm.nih.gov/pubmed/34755532
http://dx.doi.org/10.1161/JAHA.121.023199
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author Meijs, Timion A.
Minderhoud, Savine C. S.
Muller, Steven A.
de Winter, Robbert J.
Mulder, Barbara J. M.
van Melle, Joost P.
Hoendermis, Elke S.
van Dijk, Arie P. J.
Zuithoff, Nicolaas P. A.
Krings, Gregor J.
Doevendans, Pieter A.
Witsenburg, Maarten
Roos‐Hesselink, Jolien W.
van den Bosch, Annemien E.
Bouma, Berto J.
Voskuil, Michiel
author_facet Meijs, Timion A.
Minderhoud, Savine C. S.
Muller, Steven A.
de Winter, Robbert J.
Mulder, Barbara J. M.
van Melle, Joost P.
Hoendermis, Elke S.
van Dijk, Arie P. J.
Zuithoff, Nicolaas P. A.
Krings, Gregor J.
Doevendans, Pieter A.
Witsenburg, Maarten
Roos‐Hesselink, Jolien W.
van den Bosch, Annemien E.
Bouma, Berto J.
Voskuil, Michiel
author_sort Meijs, Timion A.
collection PubMed
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.
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spelling pubmed-87519122022-01-14 Cardiovascular Morbidity and Mortality in Adult Patients With Repaired Aortic Coarctation Meijs, Timion A. Minderhoud, Savine C. S. Muller, Steven A. de Winter, Robbert J. Mulder, Barbara J. M. van Melle, Joost P. Hoendermis, Elke S. van Dijk, Arie P. J. Zuithoff, Nicolaas P. A. Krings, Gregor J. Doevendans, Pieter A. Witsenburg, Maarten Roos‐Hesselink, Jolien W. van den Bosch, Annemien E. Bouma, Berto J. Voskuil, Michiel J Am Heart Assoc Original Research 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. John Wiley and Sons Inc. 2021-11-10 /pmc/articles/PMC8751912/ /pubmed/34755532 http://dx.doi.org/10.1161/JAHA.121.023199 Text en © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Meijs, Timion A.
Minderhoud, Savine C. S.
Muller, Steven A.
de Winter, Robbert J.
Mulder, Barbara J. M.
van Melle, Joost P.
Hoendermis, Elke S.
van Dijk, Arie P. J.
Zuithoff, Nicolaas P. A.
Krings, Gregor J.
Doevendans, Pieter A.
Witsenburg, Maarten
Roos‐Hesselink, Jolien W.
van den Bosch, Annemien E.
Bouma, Berto J.
Voskuil, Michiel
Cardiovascular Morbidity and Mortality in Adult Patients With Repaired Aortic Coarctation
title 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_short Cardiovascular Morbidity and Mortality in Adult Patients With Repaired Aortic Coarctation
title_sort cardiovascular morbidity and mortality in adult patients with repaired aortic coarctation
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8751912/
https://www.ncbi.nlm.nih.gov/pubmed/34755532
http://dx.doi.org/10.1161/JAHA.121.023199
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