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Improvement of sudden cardiac death risk prediction by enhanced ACC/AHA strategy in Chinese patients with hypertrophic cardiomyopathy.
Heart Rhythm. 2020 Apr 17;:
Authors: Liu J, Wu G, Zhang C, Ruan J, Wang D, Zhang M, Wang L, Yang Y, Li X, Wang Y, Hui R, Zou Y, Kang L, Wang J, Song L
Abstract
BACKGROUND: The lack of validated and effective sudden cardiac death (SCD) risk prediction method is the biggest barrier to perform the lifesaving treatment of prophylactic implantable cardioverter defibrillator (ICD) in Chinese patients with hypertrophic cardiomyopathy (HCM).
OBJECTIVE: This study aimed to evaluate the efficacy of three existing SCD risk prediction methods, namely 2011 American College of Cardiology Foundation and American Heart Association (ACCF/AHA) guideline, 2014 European Society of Cardiology (ESC) guideline and 2019 enhanced ACC/AHA strategy in Chinese patients with HCM.
METHODS: The present study consisted of 1369 consecutive adult HCM patients without a history of SCD events. The primary endpoint was a composite of SCD and equivalent events, namely resuscitation from cardiac arrest and appropriate ICD shock therapy for ventricular tachycardia or fibrillation.
RESULTS: During follow-up of 3.2±2.4 years, 39 patients reached SCD endpoints, among which 26 (66.7%) were correctly predicted as high-risk of SCD by 2019 enhanced ACC/AHA strategy, 20 (51.3%) by 2011 ACCF/AHA guideline, but only 5 (12.8%) by 2014 ESC guideline, prospectively. The 2019 enhanced ACC/AHA strategy showed higher C-statistics (0.647) for SCD prediction than 2011 ACCF/AHA guideline (0.598) and 2014 ESC guideline (0.605), and resulted in correct reclassification of SCD risk when compared with 2011 ACCF/AHA (Net Reclassification Index=0.113, P=0.074) and 2014 ESC guideline (Net Reclassification Index=0.245, P=0.038).
CONCLUSION: The 2019 enhanced ACC/AHA strategy showed better predictive performance for SCD risk stratification in Chinese HCM patients, with a notably high sensitivity.
PMID: 32311532 [PubMed – as supplied by publisher]
