Risk stratification of patient in Brugada syndrome: Risk score accuracy

Abstract

Risk stratification of sudden cardiac death (SCD) in Brugada syndrome (Brs) remains a challenge for physicians. A risk score was recently described by Siera et al. in 400 patients but never replicated in an independent cohort. We aim to investigate the accuracy of the Brs risk score in our prospective multicentric registry. Brs patients were prospectively enrolled from 1993 in a multicentric database and followed prospectively. All data described in the risk score were double reviewed for the study. A total of 1613 patients (mean age 45 ± 15 y, 70% male) were enrolled. At diagnosis, 411 (25%) presented a spontaneous type 1 ECG and 323 (20%) were symptomatic. The risk score was 0 in 850 patients, 1 in 283, 2 in 239, 3 in 117, 4 in 65 and 5 in 59. After a median follow-up of 5.5 (2.1–10) years, an arrythmic event occurred in 91 (5.6%) patients including 16 SCD, 27 ventricular arrhythmia and 48 appropriate therapy. The event rate at 5 year was significantly higher with a score of 5 (30.8%) than with a score of 0 (1.2%) or 1 (3.7%) ( P < 0.01). However, no statistical difference was found in intermediate risk patients (scores 2 to 4). Survival analysis confirmed those results with no differences in patients with a score of 2, 3 or 4 ( Fig. 1 ). In the largest cohort of Brs patient ever described, the risk score identify very high and low risk patient but does not allow stratifying the risk of sudden death in intermediate risk patient. Additional analysis should be performed in this large proportion of Brs patients.