Cardiovascular outcomes in adult patients with atrial septal defect: a nationwide population-based study

BackgroundThe beneficial effects of atrial septal defect (ASD) closure on cardiovascular events and mortality in adults remain undetermined. Therefore, this study aimed to investigate the long-term effects of different ASD closure methods on cardiovascular events in adults. MethodsA retrospective analysis was conducted using data obtained from the Korean National Health Insurance Service from 2002 to 2020, focusing on patients aged [≥]20 years diagnosed with ASD based on the codes provided by the Tenth revision of International Classification of Diseases codes between 2004 and 2015. Participants were categorized into the observation, device closure, and surgery groups. Propensity score matching (PSM) of variables such as sex, age, comorbidities, and medications was employed at a 2:1:1 ratio to mitigate imbalances among the groups. The Cox proportional hazards model was utilized to compare the occurrence of major adverse cardiovascular events (MACE), including stroke, myocardial infarction (MI), coronary revascularization, and all-cause death, and each individual component among the three groups. ResultsIn total, 20,643 patients with ASD were included in this study. After PSM, there were 6,636 in the observation group and 3,318 each in the device closure and surgery group. Over a 5-year follow-up period, the adjusted hazard ratios for MACE were significantly lower in the surgery (0.72; 95% CI: 0.66-0.79) and device closure groups (0.85; 95% CI: 0.78-0.92) than in the observation group. Beneficial effects on stroke and all-cause mortality were observed in both intervention groups. Additionally, a beneficial effect on coronary revascularization was observed in the surgery group, whereas the impact on MI was not significantly different between the groups. ConclusionsASD closure, whether by surgery or using a device, is associated with a decreased incidence of cardiovascular outcomes in adults. The benefits on cardiovascular outcomes vary with the type of closure method, underscoring the need for a tailored approach to manage ASD in adults. Clinical PerspectivesWhat is new? O_LICompared with no intervention, surgery exhibited a more beneficial effect in terms of MACE, followed by device closure. C_LIO_LIDevice closure appears to be more beneficial in terms of all-cause death. C_LIO_LISurgery reduced the occurrence of coronary revascularization. C_LI What are the clinical implications? O_LICardiovascular preventive effects after ASD closure (through surgery or device) were observed in adult patients with ASD when compared to the untreated individuals. C_LIO_LIThe benefits on cardiovascular outcomes vary with the type of closure method, underscoring the need for a tailored approach to manage ASD in adults. C_LI