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Open Access Highly Accessed Research article

Major adverse cardiovascular events in adult congenital heart disease: a population-based follow-up study from Taiwan

Yu-Sheng Lin12, Pi-Hua Liu3, Lung-Sheng Wu1, Yu-Ming Chen4, Chee-Jen Chang3* and Pao-Hsien Chu125*

Author Affiliations

1 Department of Cardiology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan

2 Healthcare Center, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan

3 Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taipei, Taiwan

4 Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan

5 Heart Failure Center, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan

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BMC Cardiovascular Disorders 2014, 14:38  doi:10.1186/1471-2261-14-38

Published: 21 March 2014

Abstract

Background

The aim of the present study was to identify the long-term major adverse cardiovascular events (MACE) in adult congenital heart disease (ConHD) patients in Taiwan.

Methods

From the National Health Insurance Research Database (1997-2010), adult patients (≥18 years) with ConHD were identified and compared to non-ConHD control patients. The primary end point was the incidence of MACE. Cox proportional hazards models were used to compute hazard ratios as estimates for multivariate adjusted relative risks with or without adjusting for age and sex.

Results

A total of 3,267 adult patients with ConHD were identified between 2000 and 2003 with a median follow-up of 11 years till December 31, 2010. The five most common types of ConHD were atrial septal defects, ventricular septal defects, patent ductus arteriosus, tetralogy of Fallot, and pulmonary stenosis. Overall, the incidence of MACE was 4.0-fold higher in the ConHD group compared with the controls. After adjustment for age and gender, the patients with ConHD had an increased risk of heart failure, malignant dysrhythmia, acute coronary syndrome, and stroke. The adult ConHD patients had a decreased life-long risk of MACE if they received surgical correction, especially in the patients with atrial septal defects.

Conclusions

After a median of 11 years of follow-up, the Taiwanese patients with ConHD were at an increased risk of life-long cardiovascular MACE, including heart failure, stroke, acute coronary syndrome, and malignant dysrhythmia. Surgical correction may help to decrease long-term MACE in ConHD patients, especially those with ASD.