Abstract P256: Increased Risk of Ischemic Stroke in Adolescents and Adults with Congenital Heart Disease

Introduction: Improvements in the treatment of congenital heart defects (CHD) have resulted in the majority of infants born with CHD surviving into adulthood. This new population of adolescents and adults living with CHD have unique challenges for lifelong care, such as suffering prematurely from ischemic strokes. Hypothesis: The aim of this analysis was to examine specific cardiovascular abnormalities that increase the risk of the early development of an ischemic stroke in individuals with CHD. Methods: This study included all patients diagnosed with CHD age 18-65 that sought medical care from 2011 to 2013 at the University of Colorado Hospital, the only adult CHD clinic in Colorado. There were 3,255 individuals mean±SD age of 47±13 years diagnosed with a CHD. Marelli groups were created to categorize the severity of CHD and cardiovascular comorbidities (atrial fibrillation, hypertension, congestive heart failure, and diabetes mellitus) were extracted from the medical records. Logistic regression models were performed to evaluate the association between cardiovascular comorbidities and risk for stroke, adjusting for age, sex, race, insurance status and CHD severity. Results: Of the 3,255 adolescents and young adults with CHD (52.3% male, 47.7% female), 146 (4.49%) were diagnosed with an ischemic stroke. The greatest proportion of ischemic strokes occurred in the shunt CHD severity group (Table). In the multivariable analysis of CHD patients, atrial fibrillation (OR=2.13, 95% CI 1.45-3.12, p=0.0001) and congestive heart failure (OR=2.60, 95% CI 1.52-4.44, p=0.0005) were associated with greater than a 2-fold increase in the odds of ischemic stroke after adjusting for age, sex, race, insurance status and CHD severity. Hypertension and diabetes mellitus were not associated with the risk of stroke. Conclusion: Cardiovascular comorbidities were strongly associated with the development of an ischemic stroke in adolescents and adults with CHD independent of CHD severity.