Validation of myocardial infarction diagnostics in adult patients with congenital heart defects in western Sweden

Abstract

Background: At about 1% of live births worldwide, Congenital Heart Defects (CDH) is the most common major congenital defects worldwide. Since the 1950s, survival of these patients into adulthood has increased from 20% to 95%. As a consequence, patients with a CHD are steadily increasing in numbers, age and severity of the CHD but we have limited knowledge regarding the long term consequences and succeptability for risk factors and old age. It has been suggested, for instance, that they are prone to myocardial infarction (MI), but we do not know to what extent our diagnostic criteria applies to these patients. The aim of this study is to validate the diagnostics of MI in adult patients with CHD. Method: A search was conducted in Elvis, the administative database of Västra Götalandsregionen of Sweden, and all patients with a CHD and an MI diagnosis were included. The medical records were retrieved and used to evaluate the basis for the MI diagnosis. The evaluation was performed using a modified version of a standard questionnaire for validation of potential cases of acute myocardial infarction. The diagnosis was then categorized as either correct, probable, improbable or incorrect. Results: 32 patients were eligable for this study and accessible for evaluation. 65.6% (n = 21) of MI-diagnoses were classified as correct and 81.3% (n = 26) as either correct or probable, wich is lower than MI in the general population. Cases classified as incorrect or improbable were typically the result of difficulties in evaluating signs of old myocardial infarction or myocardial damage during surgical procedures. Conclusion: Adult patients with a CHD seems to recieve an incorrect MI-diagnosis more often than in the general population, but not in the setting of the emergency ward. More studies with larger cohorts are needed.