Congenital heart disease in the coronary care unit: insights from a mexican registry

Congenital heart disease is the most common congenital condition, yet data on mortality and prognosis remain limited in middle-income countries. This study aimed to describe baseline clinical characteristics, initial admission diagnoses, and mortality rates in a cohort of patients with congenital heart disease (CHD) admitted to the coronary care unit (CCU) at our center. A prospective cohort of patients with CHD presenting to the CCU from 2005 to 2023 was analyzed.

Over 18 years, 418 patients with CHD were included, with a mean age of 34 years, 51.4% were male. Key comorbidities included diabetes (10.0%), dyslipidemia (6.9%), COPD (1.2%), heart failure (43.8%), CKD (8.1%), previous myocardial infarction (1.4%), atrial fibrillation (15.6%), and cerebrovascular disease (5.7%). Notably, 5.7% had undergone aortic valve surgery, and 20.6% had prior anticoagulant use. Diagnoses included ischemic heart disease (5.7%), valvulopathies (11.2%), infectious endocarditis (15.3%), cardiomyopathies (2.9%), pericarditis (2.2%), aortic-related conditions (13.9%), rhythm disorders (22.0%), prosthetic dysfunction (3.8%), cardiopulmonary conditions (13.4%), and hypertensive crises (1.2%) (Table 1). In terms of disease complexity, AHA classification showed that 13.5% were category 1, 55.0% were category 2, and 31.5% were category 3. Similarly, the ESC classification placed 13.5% in category 1, 54.8% in category 2, and 31.7% in category 3. The Physiological classification (ACHD-AP) indicated that 3.4% were in category 1, 9.9% in category 2, 51.6% in category 3, and 35.2% in category 4. Median values with 25th and 75th percentiles for hemodynamic parameters included: LVEF at 54% (40–60%), PAP at 46 mmHg (31–67 mmHg), creatinine at 1 mg/dL (0.74–1.43), albumin at 3.5 g/dL (2.9–4), TGO at 30 U/L (21.1–52), TGP at 26.3 U/L (16.2–50), LDH at 360 U/L (218–598), CRP at 15.76 mg/L (4.05–58), BNP at 2870.5 pg/mL (642–12828) and max lactate at 1.5 mmol/L (1.1–2.3). Mortality rates by AHA classification were 12.5%, 18.8%, and 14.5% for categories 1, 2, and 3, respectively. ESC classification showed similar rates: 12.5% for category 1, 18.4% for category 2, and 15.2% for category 3. In the Physiological classification, mortality rates were 0%, 2.4%, 14.5%, and 25.3% for categories 1 through 4. Only the Physiological classification showed a significant association with mortality (Tables 2 and 3).

In our population, the primary diagnoses for CHD patients were arrhythmias and endocarditis, likely reflecting both the impact of prior surgical corrections and the absence of repair in some cases. With adults with congenital heart disease (ACHD) now representing 30-35% of all adult cardiovascular cases, improved survival has led to a rise in hospital and ICU admissions. For intensive care cardiologists, understanding each patient’s congenital anatomy and any corrective surgeries is crucial, as these factors may heighten their risk for critical illness.

Admission Diagnoses of Patients