Stroke in Adults With Congenital Heart Disease: Incidence, Cumulative Risk and Predictors
Background—Stroke is an important cause of morbidity and mortality, though there is a lack of comprehensive data on its incidence, cumulative risk and predictors in adult congenital heart disease (ACHD)-patients.
Methods and Results—This retrospective study of 29,638 Quebec ACHD-patients aged 18 to 64 years between 1998 and 2010 was based on province-wide administrative data. The cumulative risk of ischemic stroke estimated up to age 64 was 6.1% (95%-CI: 5.0-7.0%) in women and 7.7% (95%-CI: 6.4-8.8%) in men; the risk of hemorrhagic stroke was 0.8% (95%-CI: 0.4-1.2%) and 1.3% (95%-CI: 0.8-1.8%) respectively. Compared to rates reported for the general Quebec population, age-sex-standardized incidence rates of ischemic stroke were 9-12 times higher below age 55 and 2-4 times higher in age-group 55-64; hemorrhagic stroke rates were 5-6 times (below age 55) and 2-3 times higher. Using a combination of stepwise model selection and Bayesian model averaging, the strongest predictors of ischemic stroke were heart failure (Odds ratio (OR) age-group 18-49: 5.94 (95%-CI: 3.49-10.14), age-group 50-64: OR 1.68 (95%-CI: 1.06-2.66)), diabetes (OR 2.33 (95%-CI: 1.66-3.28)) and recent myocardial infarction (OR 8.38 (95%-CI: 1.77-39.58)).
Conclusions—Among ACHD-patients, one in eleven men and one in fifteen women suffered a stroke between age 18 and 64. Stroke-incidence was considerably higher than in the general population, especially at younger age. The most important predictors of ischemic stroke were heart failure, diabetes and recent myocardial infarction. Further research is required to see if advances in the management of ACHD may reduce this substantial stroke rate.
- Received May 5, 2015.
- Revision received September 18, 2015.
- Accepted September 24, 2015.