Development of a risk score for patients with ischaemic cardiomyopathy - 11/03/23
, Guillermo Romero-Farina b, c, 1, Lorena Herrador a, Pablo Jordán a, Carina Espinet-Coll b, María Nazarena Pizzi a, c, Aida Ribera a, d, Ignacio Ferreira-González a, d, Santiago Aguadé-Bruix b, c
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Highlights |
• | Risk score predicts risk of MACE in patients with ischaemic cardiomyopathy. |
• | Risk score comprises eight readily available variables. |
• | The risk score's ease of use may allow its implementation in clinics. |
Abstract |
Background |
Ischaemic cardiomyopathy is a leading cause of heart failure and is associated with a poor prognosis.
Aim |
To evaluate predictors of major adverse cardiovascular events (MACE) and to develop a risk score for the disease.
Methods |
All patients with ischaemic cardiomyopathy referred to a tertiary hospital between 2010 and 2018 for stress-rest gated single-photon emission computed tomography (SPECT) were included retrospectively (n=747). Clinical and gated SPECT-derived variables were analysed as predictors of MACE, a combined endpoint of cardiovascular mortality, heart failure hospitalization or myocardial infarction during follow-up. A multivariable Cox model using backwards stepwise regression with competing risks was used to select the best parsimonious model.
Results |
After a median follow-up of 4.7 years, 313 patients had MACE (41.9%). Independent predictors of MACE were previous heart failure admission, worsening angina or dyspnoea, estimated glomerular filtration rate ≤60mL/min/1.73 m2, age>73 years, diabetes, atrial fibrillation, end-diastolic volume index>83mL/m2 and>12% of scarred myocardium. A risk score ranging from 0 to 12 classified patients as at intermediate risk (event rate of 4.0 MACE per 100 person-years), high risk (11.3 MACE per 100 person-years) or very high risk (27.8 MACE per 100 person-years). The internally validated area under the curve was 0.720 (95% confidence interval 0.660–0.740) and calibration was adequate (Hosmer-Lemeshow test P=0.28) for MACE.
Conclusions |
In patients with ischaemic cardiomyopathy, a simple risk score using dichotomic and readily available variables obtained from clinical assessment and gated SPECT accurately predicts the risk of MACE.
Le texte complet de cet article est disponible en PDF.Keywords : Risk score, Ischaemic cardiomyopathy, SPECT, Prognosis
Abbreviations : AUC, CI, HF, HR, ICM, LVEF, MACE, SPECT
Plan
| ☆ | Tweet: A simple clinical score comprising HF admission, worsening symptoms, eGFR <60ml/min/1.73 m2, >73 years, DM, AF, EDVi >83ml/m2 and >12% scar accurately predicts MACE in ICM (AUC=0.720). |
Vol 116 - N° 3
P. 145-150 - mars 2023 Retour au numéro
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