Coronary Artery Disease in Adults With Coarctation of Aorta: Incidence, Risk Factors, and Outcomes

Background: Premature coronary artery disease (CAD) is common in patients with coarctation of aorta (COA), but there are limited data about any direct relationship (or lack thereof) between COA and CAD. We hypothesized that atherosclerotic cardiovascular disease risk factors, rather than COA diagnosis, was the primary determinant of CAD occurrence in patients with COA. Methods and Results: This is a retrospective study of 654 COA patients and a control group of 876 patients with valvular pulmonic stenosis and tetralogy of Fallot to determine prevalence and independent risk factors for CAD. There was no evidence of a difference in the unadjusted CAD prevalence between the COA and control groups (7.8% versus 6.3%, P=0.247), but premature CAD was more common in COA patients (4.4% versus 1.8%, P=0.002). In the analysis of a propensity-matched cohort of 126 COA and 126 control patients, there was no evidence of a difference in overall CAD prevalence (6.3% versus 5.6% versus P=0.742) and premature CAD prevalence (4.8% versus 3.2%, P=0.518). The multivariable risk factors for CAD were hypertension (odds ratio [OR] 2.14; 95% CI 1.36–3.38), hyperlipidemia (OR 3.33; 95% CI 2.02–5.47), diabetes mellitus (OR 1.98; 95% CI 1.31–3.61), male sex (OR 2.05; 95% CI 1.33–3.17), and older age per year (OR 1.06; 95% CI 1.04–1.07). Conclusions: After adjusting for atherosclerotic cardiovascular disease risk factors, we did not find evidence of a difference in CAD risk between the patients with COA and other patients with congenital heart disease.