title: Major adverse cardiovascular events in adult congenital heart disease: a population-based follow-up study from Taiwan.
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.
authors.forename: Yu-Sheng
authors.initials: YS
authors.lastname: Lin
authors.forename: Pi-Hua
authors.initials: PH
authors.lastname: Liu
authors.forename: Lung-Sheng
authors.initials: LS
authors.lastname: Wu
authors.forename: Yu-Ming
authors.initials: YM
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan. cjchang@mail.cgu.edu.tw.
authors.forename: Chee-Jen
authors.initials: CJ
authors.lastname: Chang
authors.forename: Pao-Hsien
authors.initials: PH
authors.lastname: Chu
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000453:epidemiology*; D006348:Cardiac Surgical Procedures; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology*; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult