Stroke in Adults With Coarctation of the Aorta: A National Population‐Based Study

Abstract

BackgroundAdults with repaired coarctation of the aorta (CoA) have reduced long‐term survival compared with the general population. This study aimed to determine whether CoA is independently associated with premature ischemic and hemorrhagic stroke in the contemporary era.Methods and ResultsThis was a cross‐sectional study utilizing the National Inpatient Sample database from 2005 to 2014. We hypothesized that patients with CoA are hospitalized with ischemic and hemorrhagic stroke at a younger age compared with the general population. To test this hypothesis, we compared the age at stroke in patients with and without a diagnosis of CoA using simple and multivariable weighted linear regression. Among 4 894 582 stroke discharges, 207 had a diagnosis of CoA. Patients with CoA had strokes at significantly younger age compared with patients without CoA: 18.9 years younger for all‐cause stroke (P<0.001), 15.9 years younger for ischemic stroke (P<0.001), and 28.5 years younger for hemorrhagic stroke (P<0.001), after adjusting for potential confounders. There was no significant difference in the proportion of ischemic strokes between those with and without CoA (79.2% versus 83.0%, P=0.50). However, CoA patients had a higher proportion of subarachnoid hemorrhage (11.8% versus 4.8%, P=0.039) than those without CoA. Among patients who had a hemorrhagic stroke, the prevalence of unruptured intracranial aneurysms was higher in patients with CoA compared with those without CoA (23.3% versus 2.5%, P=0.002).ConclusionsPatients with CoA have both ischemic and hemorrhagic strokes at significantly younger ages compared with the general population.

Mind the Brain: Stroke Risk in Young Adults With Coarctation of the Aorta

“…With the strides we have made in the survival of patients with CoA, we must now address the possible morbidities our patients may face as they move into their mid to late adult years. Epidemiological studies, like that of Pickard et al, 6 will be instrumental in focusing on issues that require our further attention to continue extending the remarkable achievements already accomplished in the world of congenital heart disease.…”

“…More recently, we also have learned that even patients with repaired CoA have a 10% risk of developing intracranial aneurysms and are at increased risk of stroke . The article by Pickard et al in this issue of the Journal of the American Heart Association ( JAHA ) now informs us that ischemic and hemorrhagic strokes occur at a much earlier age than in the general population and are not solely related to persistent hypertension …”

Assessment of hemodynamic responses to exercise in aortic coarctation using MRI-ergometry in combination with computational fluid dynamics

“…Even though transstenotic pressure gradients are currently decisive in the clinical decision-making process, certain complications of aortic coarctation cannot solely be explained by them. Aortic aneurysm formation as well as intracranial vascular alterations and the premature occurrence of haemorrhagic and ischemic stroke have been reported in patients with aortic coarctation 3 , 30 and were associated with altered blood flow 31 .…”

Developing case‐finding algorithms for second events of oropharyngeal cancer using administrative data: A population‐based validation study

“…In the literature, many administrative data‐based algorithms with greater than 75% sensitivity and/or PPV are considered acceptable (or classified as high) and then widely used in application studies. For example, the hypertension algorithm developed by Quan et al had 75% sensitivity, 94% specificity, and 81% PPV and was deemed as sufficiently sensitive and specific for most research and surveillance purposes …”