Mortality associated with adult congenital heart disease: Trends in the US population from 1979 to 2005
Mortality associated with adult congenital heart disease: Trends in the US population from 1979 to 2005
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DOI：
10.1016/j.ahj.2009.08.014
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发表时间：
2009-11-01
影响因子：
4.8
通讯作者：
Foster, Elyse
中科院分区：
文献类型：
--
作者：
Pillutla, Priya;Sherry, Kanaka D.;Foster, Elyse
背景过去50年的重大进展使大多数先天性心脏病患者能够存活超过童年并进入成年。来自美国的基于人口的数据是有限的关于成人survivor.Methods死亡率，我们使用疾病控制中心多种死因登记，以确定死亡率的趋势，从1979年至2005年之间的个人与先天性心脏病在美国。动脉导管未闭、主动脉缩窄和Ebstein畸形。值得注意的是，当分析所有年龄段时，与大动脉转位相关的死亡率下降了71%（P = 0.001），与法洛四联症相关的死亡率下降了40%（P <0.001）。与其他病变相关的死亡率也有所下降。在有紫绀病变的成年人中，主要的死亡原因是心律失常，其次是心力衰竭。对于非紫绀型病变的成人，1990年以前的主要原因是心律失常; 1990年以后，心肌梗死成为死亡的主要原因。在所有年龄段的死亡原因心律失常的发病率总体下降，特别是在儿童中。结论先天性心脏病患者的寿命更长。心律失常仍然是紫绀型病变患者的主要死因。心肌梗死现在是成人非紫绀型先天性心脏病的主要原因，这与晚期生存率和后天性心脏病的影响越来越大相一致。(Am Heart J 2009; 15 8：874-9.）
Background Significant advances over the last 5 decades have allowed most patients with congenital heart disease to survive well past childhood and into adulthood. Population-based data from the United States are limited regarding mortality in adult survivors.Methods We used the Center for Disease Control Multiple Cause-of-Death registry to determine trends in mortality from 1979 to 2005 among individuals with congenital heart disease in the United States.Results There were significant reductions in death rates for adults with a number of congenital defects including ventricular septal defect, patent ductus arteriosus, coarctation of the aorta, and Ebstein anomaly. Notably, when all ages were analyzed, there was a 71% decline in deaths associated with transposition of the great arteries (P = .001) and a 40% reduction in deaths associated with tetralogy of Fallot (P < .001). Mortality related to other lesions declined as well. Among adults with cyanotic lesions, the primary contributing cause of death was arrhythmia followed by heart failure. For adults with noncyanotic lesions, the major contributing cause before 1990 was arrhythmia; after 1990, myocardial infarction become the leading contributing cause of death. There was an overall decrease in the incidence of arrhythmia as the cause of death in all ages, particularly among children.Conclusions Patients with congenital heart disease are living longer. Arrhythmia remains the primary contributing cause of death for those with cyanotic lesions. Myocardial infarction is now the leading contributing cause for adults with noncyanotic congenital heart disease consistent with late survival and an increasing impact of acquired heart disease. (Am Heart J 2009; 15 8:874-9.)