A Simple Community-Based Risk-Prediction Score for Sudden Cardiac Death - 17/04/18
, Hongyan Ning, MD, MS b, Jeffrey J. Goldberger, MD c, Sanjay Mehrotra, PhD d, Donald M. Lloyd-Jones, MD, ScM bAbstract |
Background |
Although sudden cardiac death is a leading cause of death in the United States, most victims of sudden cardiac death are not identified as at risk prior to death. We sought to derive and validate a population-based risk score that predicts sudden cardiac death.
Methods |
The Atherosclerosis Risk in Communities (ARIC) Study recorded clinical measures from men and women aged 45-64 years at baseline; 11,335 white and 3780 black participants were included in this analysis. Participants were followed over 10 years and sudden cardiac death was physician adjudicated. Cox proportional hazards models were used to derive race-specific equations to estimate the 10-year sudden cardiac death risk. Covariates for the risk score were selected from available demographic and clinical variables. Utility was assessed by calculating discrimination (Harrell's C-index) and calibration (Hosmer-Lemeshow chi-squared test). The white-specific equation was validated among 5626 Framingham Heart Study participants.
Results |
During 10 years' follow-up among ARIC participants (mean age 54.4 years, 52.4% women), 145 participants experienced sudden cardiac death; the majority occurred in the highest quintile of predicted risk. Model covariates included age, sex, total cholesterol, lipid-lowering and hypertension medication use, blood pressure, smoking status, diabetes, and body mass index. The score yielded very good internal discrimination (white-specific C-index 0.82; 95% confidence interval [CI], 0.78-0.85; black-specific C-index 0.75; 95% CI, 0.68-0.82) and very good external discrimination among Framingham participants (C-index 0.82; 95% CI, 0.79-0.86). Calibration plots indicated excellent calibration in ARIC (white-specific chi-squared 5.3, P = .82; black-specific chi-squared 4.1, P = .77), and a simple recalibration led to excellent fit within Framingham (chi-squared 2.1, P = 0.99).
Conclusions |
The proposed risk scores may be used to identify those at risk for sudden cardiac death within 10 years and particularly classify those at highest risk who may merit further screening.
Le texte complet de cet article est disponible en PDF.Keywords : Coronary heart disease, Risk factors, Sudden cardiac death
Plan
| Funding: This study was supported by the National Heart, Lung, and Blood Institute [R21 HL085375]. |
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| Conflicts of Interest: JJG serves as the Director of the Path to Improved Risk Stratification, NFP, a not-for-profit think tank on risk stratification for sudden cardiac death that has received grant funding from the National Institutes of Health and unrestricted educational grants from a number of industry sources, including Boston Scientific, GE Medical, Gilead, Medtronic, and St. Jude Medical. All other authors report no conflicts of interest. |
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| Authorship: All authors had access to the study data and contributed to writing the manuscript. DML-J takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. |
Vol 131 - N° 5
P. 532 - mai 2018 Retour au numéro
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