Abstract WMP100: Cardiovascular Outcomes in Adult Patients With Atrial Septal Defect: A Nationwide Population-Based Study

Abstract

Objective: It is currently unknown whether closing atrial septal defects (ASDs) could reduce cardiovascular events and mortality in adult patients with ASD. This study aims to investigate the long-term effects of different ASD closure methods on cardiovascular events in adults. Methods: We conducted a retrospective analysis of the Korean National Health Insurance Service benefit records spanning from 2002 to 2020. From this dataset, we identified patients aged 20 years or older who received a diagnosis of ASD based on ICD-10 codes between 2004 and 2015. Participants were categorized into three groups: observation, device closure, and surgery closure, based on the method of ASD closure. To mitigate imbalances among the groups, we employed propensity score matching (PSM) in a 2:1:1 ratio, considering variables such as sex, age, comorbidities, and medications. We utilized the Cox proportional hazard model to compare the occurrence of major adverse cardiovascular events (MACE), including stroke, myocardial infarction (MI), and all-cause death, and each component among the three groups. Results: A total of 20,643 ASD patients were initially included in the study. After PSM, 6,636 patients were assigned in the observation group, and 3,318 patients were selected in each of the device and surgery closure groups. Over a 5-year follow-up period, the adjusted hazard ratios (aHRs) for MACE were 0.72 (0.66-0.79) in the surgery group and 0.85 (0.78-0.92) in the device group, using the observation group as the reference. For stroke, the aHRs were 0.46 (0.39-0.56) in the surgery group and 0.47 (0.39-0.57) in the device group. Regarding MI, the effect between the surgery/device closure groups and the observation group was comparable [0.83 (0.64-1.06) and 0.98 (0.77-1.25), respectively]. The aHRs for all-cause death were 0.43 (0.34-0.55) in the surgery group and 0.18 (0.12-0.26) in the device group. Conclusions: The favorable cardiovascular outcomes observed after ASD closure (surgery or device) were sustained even in adult ASD patients when compared to the observation group. Moreover, the preventive effect on each cardiovascular outcome after ASD closure varied depending on the treatment approach.