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Background and Aims: The life expectancy of adult patients with congenital heart disease (ACHD) has improved, thus shifting the research focus towards age-related comorbidities to continue to improve patient outcomes. This study aimed to investigate all-cause mortality and recurrent acute myocardial infarction (AMI) in adults with and without congenital heart disease.

Methods: A nationwide case control study was conducted between 2000 and 2022. Patients with ACHD (n = 214) and controls (n = 275 377) who experienced their first AMI were identified. Of these, each patient (n = 213) with ACHD was matched with 10 controls (n = 2092) based on age, sex, hypertension, diabetes, hyperlipidaemia, and history of percutaneous coronary intervention or coronary artery bypass grafting. Mortality and recurrent AMI were assessed using unadjusted and adjusted Cox regression for matching and other clinical covariates.

Results: Patients with ACHD were younger (58 ± 14 years) than controls (70 ± 12 years) before the matching (P < .001). The mean follow-up time was 6.5 and 7.3 years for patients with ACHD and controls, respectively. There was no significant difference in mortality or recurrent AMI rates at 1 year between patients with ACHD and matched controls. The mortality rate was higher in ACHD at 10 years of follow-up (hazard ratio 1.4, 95% confidence interval 1.0–1.9) but did not remain after adjustment.

Conclusions: This study suggests that survival rates and the incidence of recurrent AMI in ACHD patients are similar to those of controls. Since patients with ACHD share similar cardiovascular risk factors as the general population, promoting healthy lifestyles and proactive risk management is crucial to mitigate acquired heart disease.