Factors associated with coronary artery disease and stroke in adults with congenital heart disease

Jouke P Bokma, Ineke Zegstroo, Joey M Kuijpers, Thelma C Konings, Roland R J van Kimmenade, Joost P van Melle, Philippine Kiès, Barbara J M Mulder, Berto J Bouma

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OBJECTIVE: To determine factors associated with coronary artery disease (CAD) and ischaemic stroke in ageing adult congenital heart disease (ACHD) patients.

METHODS: We performed a multicentre case-control study, using data from the national CONgenital CORvitia (CONCOR) registry to identify ACHD patients within five participating centres. Patients with CAD were matched (1:2 ratio) with ACHD patients without CAD on age, CHD defect group and gender. Patients with ischaemic stroke (or transient ischaemic attack) were matched similarly. Medical charts were reviewed and a standardised questionnaire was used to determine presence of risk factors.

RESULTS: Of 6904 ACHD patients, a total of 55 cases with CAD (80% male, mean age 55.1±12.4 years) and 56 cases with stroke (46% male, mean age 46.9±15.2) were included and matched with control patients. In multivariable logistic regression analysis, traditional atherosclerotic risk factors (hypertension (OR 2.45; 95% CI 1.15 to 5.23), hypercholesterolaemia (OR 3.99; 95% CI 1.62 to 9.83) and smoking (OR 2.25; 95% CI 1.09 to 4.66)) were associated with CAD. In contrast, these risk factors were not associated with ischaemic stroke. In multivariable analysis, stroke was associated with previous shunt operations (OR 4.20; 95% CI 1.36 to 12.9), residual/unclosed septal defects (OR 2.38; 95% CI 1.03 to 5.51) and left-sided mechanical valves (OR 2.67; 95% CI 1.09 to 6.50).

CONCLUSIONS: Traditional atherosclerotic risk factors were associated with CAD in ACHD patients. In contrast, ischaemic stroke was related to factors (previous shunts, septal defects, mechanical valves) suggesting a cardioembolic aetiology. These findings may inform surveillance and prevention strategies.

Original languageEnglish
Pages (from-to)574-580
Number of pages7
Issue number7
Early online date28 Aug 2017
Publication statusPublished - 1 Apr 2018

Cite this

Bokma, J. P., Zegstroo, I., Kuijpers, J. M., Konings, T. C., van Kimmenade, R. R. J., van Melle, J. P., ... Bouma, B. J. (2018). Factors associated with coronary artery disease and stroke in adults with congenital heart disease. Heart, 104(7), 574-580. https://doi.org/10.1136/heartjnl-2017-311620