As survival among adults with congenital heart disease (ACHD) continues to improve, acquired cardiovascular conditions such as acute myocardial infarction (AMI) are becoming increasingly relevant in long-term care. A nationwide case-control study published in the European Heart Journal evaluated mortality and recurrent AMI outcomes in adults with congenital heart disease compared with individuals without congenital heart disease.

The study included patients identified between 2000 and 2022 who experienced a first AMI. Investigators identified 214 patients with ACHD and 275,377 controls without congenital heart disease. After matching for age, sex, hypertension, diabetes, hyperlipidemia, and prior coronary revascularization procedures, 213 patients with ACHD were compared with 2,092 matched controls.

Mortality and recurrent AMI outcomes were analyzed using Cox regression models with adjustment for matching variables and additional clinical covariates. Mean follow-up duration was 6.5 years in the ACHD group and 7.3 years among controls.

Findings

• Before matching, patients with ACHD experienced first AMI at a younger age compared with controls (58±14 vs. 70±12 years; P<0.001).
• No significant difference in mortality or recurrent AMI was observed at 1 year between ACHD patients and matched controls.
• At 10 years, unadjusted mortality was higher among patients with ACHD (HR 1.4; 95% CI 1.0-1.9).

The findings suggest that adults with congenital heart disease who experience a first myocardial infarction may have similar adjusted long-term survival and recurrent AMI risk compared with matched controls.