Abstract 19374: Predictors of Cardiovascular Events in Patients after Coarctation Repair
Background: Long-term outcome after coarctation repair (CoA) is characterized by a significant cardiovascular morbidity and mortality Little is known on the predictive value of clinical parameters on cardiovascular events in CoA. The aim of this study is to determine the predictive value of clinical parameters on cardiovascular events.
Methods: 160 adult CoA patients were identified in 2001 and followed for the occurrence of cardiovascular events until 2012. Echocardiography, ambulatory blood pressure monitoring, CMR imaging, and imaging of the carotid arteries (CIMT) were performed at baseline. The composite endpoint included: myocardial infarction, ischemic or hemorraghic cerebrovascular events, heart failure, aortic aneurysm formation requiring an intervention, and sudden cardiac death.
Results: 160 adult CoA patients were included (mean age of 31.7 ±11.5 years and mean age at repair 4.3 ±6.6 years, 64% male) and followed with a mean follow-up of 10.10 ± 0.71 years; 18 (11%) patients suffered from an event during follow-up. Five patients (3%) had myocardial infarction, 4 (3%) an ischemic cerebrovascular accident, 7 (4%) an aortic aneurysm which needed surgical intervention, and 2 patients (1%) died suddenly. Univariate Cox regression analysis revealed that older age (ß = 1.08, P < 0.001), elevated total cholesterol levels (β = 4.4; p = 0.03), elevated LDL cholesterol levels (β = 3.1, P = 0.09) and the carotid intima media thickness (β = 309.6; p = 0.007) were associated with an event during follow-up. Multivariate analysis demonstrated that patients with older age (β = 9.8, P = 0.02), increased total cholesterol levels (β = 1.24, P = 0.09) and an increased CIMT (β = 12.5, P = < 0.001) were specifically at risk for a cardiovascular event during follow-up. Cumulative event-free survival was significantly lower in patients with a CIMT above 0.61 mm (median) (P = 0.09, HR: 2.23) (Figure 1)
Conclusions: During 10 year follow up almost 11% of CoA patients suffered from a cardiovascular event. Older age, elevated cholesterol levels and an increased CIMT were the main determinants. Overall event-free survival is significantly lower in patients with an increased CIMT. Intervention with statin therapy might improve the prognosis of these young patients in the future.
- © 2012 by American Heart Association, Inc.