1. A nationwide Swedish study demonstrated that patients with congenital heart disease are at an increased risk of developing ischemic stroke compared to controls.
Evidence Rating Level: 3 (Average)
Congenital heart disease (CHD) is the most common major congenital anomaly, and it is associated with an increased risk of complications such as arrythmias and heart failure. Although studies have demonstrated increased risk of ischemic stroke (IS) in patients with CHD, there are limited studies about long-term outcomes in such patients. This case-control study aimed to evaluate the cumulative incidence and risk of developing IS as well as determine risk of developing recurrent and all-cause mortality after IS in patients with CHD compared to controls. Data collection included 88,700 patients with CHD (50.6% men) and 890,450 controls (51% men) without CHD. It demonstrated that patients with CHD to develop IS were control median age, 66.0 [IQR, 57.1–73.4] years; p<0.001). Patients with CHD had a 5-fold increased risk of developing IS compared to their controls (HR, 5.01; 95% CI, 4.81–5.22). The risk of developing recurrent IS was 34% lower in patients with CHD compared to their controls (HR, 0.66; 95% CI, 0.56–0.78). However, patients with CHD were younger than the controls at the recurrent IS (median age, 61.6[IQR, 50.3–70.6] years versus 71.0[IQR, 65.0–77.0] years; p<0.001). Similarly, the risk of all-cause mortality in patients with CHD was around half that of controls (HR, 0.53; 95% CI, 0.49–0.58) However, patients with CHD who died after an IS were younger compared to their controls (median age, 67.9[IQR, 53.7–76.6] years for versus 73.0[IQR, 66.1–78.6] years for controls; p<0.001). Overall, this study demonstrated that patients with CHD had an increased risk of developing IS, yet, their risk of recurrent IS and all-cause mortality was lower compared to controls. Although this study had a large sample size and limited attrition, future better-quality evidence such as prospective cohort studies are needed to further establish these conclusions.
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