title: Stroke in Adults With Congenital Heart Disease: Incidence, Cumulative Risk, and Predictors.
abstract: BACKGROUND
  Stroke is an important cause of morbidity and mortality, although there is a lack of comprehensive data on its incidence, cumulative risk, and predictors in patients with adult congenital heart disease.
  
  
  RESULTS
  This retrospective study of 29 638 Quebec patients with adult congenital heart disease 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 years was 6.1% (95% confidence interval [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 with rates reported for the general Quebec population, age-sex standardized incidence rates of ischemic stroke were 9 to 12 times higher below age 55 years and 2 to 4 times higher in the age group 55 to 64 years; hemorrhagic stroke rates were 5 to 6 times (age <55 years) and 2 to 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 for age group 18-49 years, 5.94 [95% CI, 3.49-10.14], odds ratio for age group 50-64 years, 1.68 [95% CI, 1.06-2.66]), diabetes mellitus (odds ratio, 2.33 [95% CI, 1.66-3.28]), and recent myocardial infarction (odds ratio, 8.38 [95% CI, 1.77-39.58]).
  
  
  CONCLUSIONS
  Among patients with adult congenital heart disease, 1 in 11 men and 1 in 15 women experienced a stroke between ages 18 and 64 years. Stroke incidence was considerably higher than in the general population, especially at a younger age. The most important predictors of ischemic stroke were heart failure, diabetes mellitus, and recent myocardial infarction. Additional research is required to see whether advances in the management of adult congenital heart disease may reduce this substantial stroke rate.
authors.affiliation: From the McGill Adult Unit for Congenital Heart Disease Excellence, Montreal, Québec, Canada (J.L., J.T., M.K., L.G., A.J.M.); Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada (J.M.B., A.J.M.); and Division of Cardiology, Jewish General Hospital, Montreal, Québec, Canada (J.T.).
authors.forename: Jonas
authors.initials: J
authors.lastname: Lanz
authors.affiliation: From the McGill Adult Unit for Congenital Heart Disease Excellence, Montreal, Québec, Canada (J.L., J.T., M.K., L.G., A.J.M.); Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada (J.M.B., A.J.M.); and Division of Cardiology, Jewish General Hospital, Montreal, Québec, Canada (J.T.).
authors.forename: James M
authors.initials: JM
authors.lastname: Brophy
authors.affiliation: From the McGill Adult Unit for Congenital Heart Disease Excellence, Montreal, Québec, Canada (J.L., J.T., M.K., L.G., A.J.M.); Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada (J.M.B., A.J.M.); and Division of Cardiology, Jewish General Hospital, Montreal, Québec, Canada (J.T.).
authors.forename: Judith
authors.initials: J
authors.lastname: Therrien
authors.affiliation: From the McGill Adult Unit for Congenital Heart Disease Excellence, Montreal, Québec, Canada (J.L., J.T., M.K., L.G., A.J.M.); Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada (J.M.B., A.J.M.); and Division of Cardiology, Jewish General Hospital, Montreal, Québec, Canada (J.T.).
authors.forename: Mohammed
authors.initials: M
authors.lastname: Kaouache
authors.affiliation: From the McGill Adult Unit for Congenital Heart Disease Excellence, Montreal, Québec, Canada (J.L., J.T., M.K., L.G., A.J.M.); Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada (J.M.B., A.J.M.); and Division of Cardiology, Jewish General Hospital, Montreal, Québec, Canada (J.T.).
authors.forename: Liming
authors.initials: L
authors.lastname: Guo
authors.affiliation: From the McGill Adult Unit for Congenital Heart Disease Excellence, Montreal, Québec, Canada (J.L., J.T., M.K., L.G., A.J.M.); Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada (J.M.B., A.J.M.); and Division of Cardiology, Jewish General Hospital, Montreal, Québec, Canada (J.T.).
authors.forename: Ariane J
authors.initials: AJ
authors.lastname: Marelli
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology*; D055815:Young Adult
keywords: congenital; epidemiology; heart defects; incidence; risk factors; stroke