Stroke in Adults With Congenital Heart Disease: Incidence, Cumulative Risk, and Predictors

BACKGROUND—Stroke is an important cause of morbidity and mortality, although there is a lack of comprehensive data on its incidence, cumulative risk, and predictors in patients with adult congenital heart disease. METHODS AND RESULTS—This retrospective study of 29 638 Quebec patients with adult congenital heart disease aged 18 to 64 years between 1998 and 2010 was based on province-wide administrative data. The cumulative risk of ischemic stroke estimated up to age 64 years was 6.1% (95% confidence interval [CI], 5.0–7.0%) in women and 7.7% (95% CI, 6.4–8.8%) in men; the risk of hemorrhagic stroke was 0.8% (95% CI, 0.4–1.2%) and 1.3% (95% CI, 0.8–1.8%), respectively. Compared with rates reported for the general Quebec population, age-sex standardized incidence rates of ischemic stroke were 9 to 12 times higher below age 55 years and 2 to 4 times higher in the age group 55 to 64 years; hemorrhagic stroke rates were 5 to 6 times (age