Prevalence And Risk Factors Of Coronary Artery Disease In Congenital Heart Disease Patients Older Than 50 Years

Backgroud:Congenital heart disease(CHD)is a congenital structural anomaly of heart or great vessels.The overall prevalence of CHD is about 0.9%.Atrial septal defect(ASD),ventricular septal defect(VSD)and patent ductus arteriosus(PDA)were the most common CHDs and the prevalences is 0.09%、0.3%and 0.06%in infancy,and 0.06%,0.03%and 0.05%in adulthood,respectively.Due to lack of specific early symptoms,many patients do not recognized they had CHD until adulthood.The risk of acquired cardiovascular diseases,especially,coronary artery disease(CAD)increases when CHD patients grow old.Therefore,CAD has become an issue in CHD patients,And as the electrocardiogram in CHD patients is different from that in the general population,it it difficult to diagnose CAD by using this routine examination method.CAD affects not only the perioperative and long-term outcomes of cardiac and major vascular surgery,but also the decision-making.Therefore it is important for the adult CHD patients to receive Coronary angiography(CAG)before surgery or intervention therapy.Patients older than 50 years old should receive CAG before CHD or and intervention therapy in the common view of Chinese medical experts.Objective:To investigate the prevalence of CAD in CHD patients older than 50 years and the risk factors for CAD including age,sex,body mass index,blood lipids,history of hypertension and diabetes mellitus and shunt location.Method:Patients with a single shunt CHD admitted to our hospital between January 2010 to October 2017 were enrolled after evaluated clinically and by echocardiography and(or)angiocardiography.Inclusion criteria:(1)age≥50 years;(2)patients with only one single shunt location at interatrial septum,interventricular septum or great vessels level.Exclusion criteria:(1)patients with combined shunt locations or complex anomalies;(2)premium ASD;(3)postoperative CHD patients;(4)CHD with primary heart valvular disease;(5)patients complicating other diseases(including cancer,thyroid disease,bleeding disease,etc.)are contraindicated to cardiac catheterization and surgery.CAD is defined as stenosis ≥50%in diameter in major coronary artery.The relationship between prevalence of CAD and risk factors including age,gender,body mass index(BMI),lipids,history of hypertension and diabetes mellitus,cyanosis,and shunt locations was analyzed.Results:1002 CHD patients(272 males and 730 females)aged 57.9 ± 6.0 years were included In this study,including 679 patients with ASD,94 patients with VAD and 229 patients with PDA.The prevalence of diabetes,hypertension and both was 7.0%,25.8%and 3.3%,respectively.There were still 14 patients with cyanosis.CAD was found in 148 CAD patients by CAG,the prevalence was 10.1%in females and 27.2%in males.The prevalence of CAD in males was significantly higher than that in females(P<0.001).The prevalence of CAD in patients aged 50-54,55-59,60-64 and older than 65 years old was 10.8%,11.2%,17.4%and 28.5%,respectively.There were no significant differences between the CAD group and the non-CAD group in cyanosis(0 vs 14,P=0.244),level of total cholesterol[(4.61 ± 1.09)mmol/L vs(4.69 ± 0.97)mmol/L,P = 0.358],serum triglyceride[(1.51 ± 0.84)mmol/L vs(1.47 ± 0.92)mmol/L,P = 0.635]and low density lipoprotein-cholesterol concentration(LDL-C)[(2.76 ± 0.85)mmol/L vs(2.77 ± 0.78)mmol/L,P = 0.988).There were significant differences between the CAD group and the non-CAD group in BMI[(24.2 ± 3.1)Kg/m2 vs(23.6 ± 3.3)Kg/m2,P = 0.018],history of hypertension(62 vs 197,P<0.001)and diabetes mellitus(29 vs 41,P<0.001).Multivariate logistic regression analysis showed that age(OR 1.071),sex(OR 3.076),history of hypertension(OR 2.513)and diabetes mellitus(OR 3.688)and shunt locations(relative to PDA,ASD OR 3.526 and VSD OR 3.242)were the independent risk factors for CAD in patients with CHD.The prevalence of CAD in male patients with ASD and VSD aged 50-54 years old was 21.7%and 15.0%,in female patients with ASD and VSD was 8.1%and 18.2%,but only 5.6%in female with PDA aged from 50 to 54 years old.The prevalence of CAD in male patients with ASD and VSD,male patients with ASD and VSD,and female patients with PDA aged from 50 to 54 years old without history of hypertension and diabetes mellitus was 13.1%,6.3%and 2.1%,respectively.Conclusion:1:Traditional risk factors for CAD such as age,gender,history of hypertension and diabetes mellitus are also risk factors for CAD in CHD patients,but BMI and blood lipids are not.Locations of shunts have an impact on CAD prevalence in patients with CHD.2:It remained to discussed whether it is appropriate for CHD patients to receive CAG at 50 years old.We should take into account the gender,the location of shunt,history of hypertension and diabetes mellitus.Routine preoperative CAG in patients with ASD and VSD without history of diabetes and hypertension is indicative even though they are younger than 50 years old,which is not the case in patients with PDA.