Background The aim of this study was to evaluate long-term survival and freedom from coronary artery reintervention after the arterial switch operation (ASO). Methods and Results This single-center nationwide retrospective study included consecutive children who underwent ASO between 1990 and 2016 (n=605). Long-term outcomes were obtained by cross-mapping individual data with the National Death Registry and the National Registry of Cardiovascular Interventions for adults. A control group was randomly retrieved at a 1:10 ratio from the National Birth and Death Registries. Early mortality was 3.3% and late mortality was 1.7% during a median follow-up of 10 (interquartile range, 5-16) years. The probability of overall survival at 20 years after ASO was 94.9% compared with 99.5% in the background population (hazard ratio [HR] 15.6; 95% CI, 8.9-27.5, P<0.001). Independent multivariable predictors of worse survival were an intramural coronary artery (HR, 5.2; 95% CI, 1.8-15.2, P=0.002) and period of ASO 1990 to 1999 (HR, 4.6; 95% CI, 1.5-13.6, P<0.001). Fourteen patients (2.3%) required 16 coronary artery reoperations. Freedom from coronary artery reintervention at 20 years after ASO was 96%. The only independent multivariable predictor associated with a higher hazard for coronary artery reintervention was an intramural coronary artery (HR, 33.9; 95% CI, 11.8-97.5, P<0.001). Conclusions Long-term survival after ASO is excellent. Coronary artery reinterventions are rare. An intramural coronary artery was an independent predictor associated with a higher risk for coronary artery reintervention and death, regardless of the surgical period.
- MeSH
- anomálie koronárních cév diagnostické zobrazování epidemiologie chirurgie MeSH
- časové faktory MeSH
- dítě MeSH
- doba přežití bez progrese choroby MeSH
- dospělí MeSH
- hodnocení rizik MeSH
- kojenec MeSH
- korekce transpozice velkých arterií * škodlivé účinky mortalita MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- novorozenec MeSH
- pooperační komplikace mortalita chirurgie MeSH
- předškolní dítě MeSH
- přežívající MeSH
- registrace MeSH
- reoperace MeSH
- replantace * škodlivé účinky mortalita MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- transpozice velkých cév diagnostické zobrazování epidemiologie chirurgie MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
- Geografické názvy
- Česká republika MeSH
Sudden deaths in young competitive athletes are highly visible events with substantial impact on the physician and lay communities. However, the magnitude of this public health issue has become a source of controversy. METHODS AND RESULTS: To estimate the absolute number of sudden deaths in US competitive athletes, we have assembled a large registry over a 27-year period using systematic identification and tracking strategies. A total of 1866 athletes who died suddenly (or survived cardiac arrest), 19+/-6 years of age, were identified throughout the United States from 1980 to 2006 in 38 diverse sports. Reports were less common during 1980 to 1993 (576 [31%]) than during 1994 to 2006 (1290 [69%], P<0.001) and increased at a rate of 6% per year. Sudden deaths were predominantly due to cardiovascular disease (1049 [56%]), but causes also included blunt trauma that caused structural damage (416 [22%]), commotio cordis (65 [3%]), and heat stroke (46 [2%]). Among the 1049 cardiovascular deaths, the highest number of events in a single year was 76 (2005 and 2006), with an average of 66 deaths per year (range 50 to 76) over the last 6 years; 29% occurred in blacks, 54% in high school students, and 82% with physical exertion during competition/training, whereas only 11% occurred in females (although this increased with time; P=0.023). The most common cardiovascular causes were hypertrophic cardiomyopathy (36%) and congenital coronary artery anomalies (17%). CONCLUSIONS: In this national registry, the absolute number of cardiovascular sudden deaths in young US athletes was somewhat higher than previous estimates but relatively low nevertheless, with a rate of <100 per year. These data are relevant to the current debate surrounding preparticipation screening programs with ECGs and also suggest the need for systematic and mandatory reporting of athlete sudden deaths to a national registry.
- MeSH
- anomálie koronárních cév epidemiologie mortalita MeSH
- dospělí MeSH
- financování organizované MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- náhlá smrt epidemiologie MeSH
- příčina smrti trendy MeSH
- registrace MeSH
- rizikové faktory MeSH
- sportovní výkon trendy MeSH
- sporty trendy MeSH
- věkové faktory MeSH
- vrozené srdeční vady epidemiologie mortalita MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- srovnávací studie MeSH
- Geografické názvy
- Spojené státy americké MeSH
Úvod: Lokalizované nebo difuzní rozšíření koronárních tepen (koronární ektazie) je dobře známým, ale vzácným angiografickým nálezem. Incidence výskytu ektazií je v literatuře uváděna od 0,2% do 5,3%. Naším cílem bylo stanovit výskyt, charakteristiku a prognózu těchto pacientů v České republice. Metody a výsledky: V průběhu jednoho roku podstoupilo koronarografii ve třech kardiocentrech v České republice 6997 pacientů. Z tohoto souboru byli vybráni a dále sledováni po dobu 12 měsíců pacienti s nálezem koronárních ektazií, což bylo 52 osob, tj. 0,7%. Nejčastěji byla postižena pravá koronární tepna. Velkou část (82,7 %) souboru tvořili muži. Průměrný věk byl 65 let; 23% pacientů mělo diabetes mellitus, 78,8% byli hypertonici, 61,5% trpělo dyslipidemií a více než polovina pacientů byli kuřáci (55,8 %). Pacienti s ektaziemi bez koexistující obliterující aterosklerózy neměli v anamnéze infarkt myokardu a v průběhu jednoletého sledování nebylo zaznamenáno v této skupině žádné úmrtí. Při srovnání tradičních rizikových faktorů pro ischemickou chorobu srdeční a mortality mezi pacienty s izolovanými ektaziemi a pacienty s ektaziemi v kombinaci se stenotickým postižením koronárních tepen nebyly nalezeny statisticky významné rozdíly. Závěr: Incidence koronárních ektazií v naší studii byla 0,7%. Velkou část pacientů tvořili starší muži, kteří trpěli hypertenzí, dyslipidemií a kouřili. Nejčastěji postiženou tepnou byla pravá koronární arterie. Izolované koronární ektazie se vyskytovaly u 15,4% pacientů a v této skupině nedošlo k žádnému úmrtí.
Background: Localized or diffuse dilatation of the coronary arteries (coronary ectasia) is a well-known, albeit rare, angiographic finding. Its incidence ranges from 0.2% to 5.3% in the literature. We aimed to determine its incidence, baseline characteristics, and prognosis in patients in the Czech Republic. Methods and Results: All 6,997 consecutive coronary angiograms performed through 12 months in three cardiac centers in the Czech Republic were analyzed. The follow-up period was one year. Of the 6,997 patients, only 52 (0.7%) were assigned to the coronary artery ectasia group. The right coronary artery was the most common vessel affected by coronary artery ectasia. The majority (82.7%) were males. The median age was 65 years. A total of 23% of patients were diagnosed to have diabetes mellitus, 78.8% hypertension, 61.5% dyslipidemia, more than half were smokers (55.5%). Patients with coronary artery ectasia without coexisting coronary artery disease had no history of myocardial infarction. No death occurred in this group throughout the follow-up period of one year. A comparison of traditional risk factors for coronary artery disease and mortality between patients with isolated coronary artery ectasia and those with ectasia coexisting with stenosed coronary artery disease revealed no statistically significant differences in its incidence. Conclusion: The incidence of coronary artery ectasia in our study was 0.7%. The majority of patients were males; they had hypertension and dyslipidemia, and a history of cigarette smoking. The most affected vessel was the right coronary artery. Isolated coronary ectasia occurred in 15.4%, no death in this group was noted.
- MeSH
- anomálie koronárních cév diagnóza epidemiologie MeSH
- arteria pulmonalis MeSH
- dospělí MeSH
- koronární angiografie MeSH
- lidé MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
