Abstract
Implantable cardiodefibrillators (ICDs) have proven benefit in preventing sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HC), making risk stratification essential. Data on the predictive accuracy on the European Society of Cardiology (ESC) risk scoring system have been conflicting. We independently evaluated the ESC risk scoring system in our cohort of patients with HC from a large tertiary center and compared this with previous guidance by the American College of Cardiology Foundation and Heart Association (ACCF/AHA). Risk factor profiles, 5-year SCD risk estimates, and ICD recommendations, as defined by the ACCF/AHA and ESC guidelines, were retrospectively ascertained for 288 HC patients with and without SCD or equivalent events at our center. In the SCD group (n = 14), a significantly higher proportion of patients would not have met the criteria for an ICD implant using the ESC scoring algorithm compared with ACCF/AHA guidance (43% vs 7%, p = 0.029). In those without SCD events (n = 274), a larger proportion of individuals not requiring an ICD was identified using the ESC risk score model compared with the ACCF/AHA model (82% vs 57%; p < 0.0001). Based on risk stratification criteria alone, 5 more individuals with a previously aborted SCD event would not have received an ICD with the ESC risk model compared with the ACCF/AHA risk model. In conclusion, we found that the current ESC scoring system potentially leaves more high-risk patients unprotected from sudden death in our cohort of patients.
Highlights
Predictive risk scores and Implantable cardiodefibrillators (ICDs) implant recommendations based on the European Society of Cardiology (ESC) 2014 and AHA/ACCF 2011 and 2003 guidelines were determined by assessing the case records in all these patients
Maron et al reported a much greater proportion of sudden cardiac death (SCD) patients who would not have achieved a recommendation for an ICD implant with the risk score algorithm compared with the 2011 model (59% vs 12%)
Even though Vriesendorp et al demonstrated that a lower proportion of the SCD group would not have been recommended for an ICD implant based on the 2014 risk score model compared with the 2011 model (30% vs 50%), this is not an insignificant proportion and their analysis was limited to half of their total SCD cohort (20 of 41).[11]
Summary
As the aim of the study was to retrospectively assess the predictive accuracy of recommendations using different guidelines, we included patients with HC whose initial presentation was an SCD event and survived
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