Comparative Evaluation of Four Risk Scores for Predicting Mortality in Patients With Implantable Cardioverter-defibrillator for Primary Prevention

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• 作者：Moisé ; s Rodrí ; guez-Ma&ntilde ; ero^a ; Emad Abu Assi^a ; Juan Miguel Sá ; nchez-G&oacute ; mez^b ; Juan Ferná ; ndez-Armenta^c ; Ernesto Dí ; az-Infante^d ; Ignacio Garcí ; a-Bolao^e ; Juan Benezet-Mazuecos^f ; Ana André ; s Lahuerta^g ; Ví ; ctor Exp&oacute ; sito-Garcí ; a^h ; Vicente Bertomeu-Gonzá ; lezⁱ ; Á ; lvaro Arce-Le&oacute ; n^j ; Marí ; a Teresa Barrio-L&oacute ; pez^k ; Rafael Peinado^l ; Luis Martí ; nez-Sande^a ; Miguel A. Arias^m ; ^&loz ; ; ^{maapalomares@secardiologia.es" class="auth_mail" title="E-mail the corresponding author}
• 关键词：HF ; heart failure ; ICD ; implantable cardioverter&ndash ; defibrillator ; RS ; risk score
• 刊名：Revista Española de Cardiología (English Edition)
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：69
• 期：11
• 页码：1033-1041
• 全文大小：350 K

文摘

Several clinical risk scores have been developed to identify patients at high risk of all-cause mortality despite implantation of an implantable cardioverter-defibrillator. We aimed to examine and compare the predictive capacity of 4 simple scoring systems (MADIT-II, FADES, PACE and SHOCKED) for predicting mortality after defibrillator implantation for primary prevention of sudden cardiac death in a Mediterranean country.

Methods

A multicenter retrospective study was performed in 15 Spanish hospitals. Consecutive patients referred for defibrillator implantation between January 2010 and December 2011 were included.

Results

A total of 916 patients with ischemic and nonischemic heart disease were included (mean age, 62 ± 11 years, 81.4% male). Over 33.4 ± 12.9 months, 113 (12.3%) patients died (cardiovascular origin in 86 [9.4%] patients). At 12, 24, 36, and 48 months, mortality rates were 4.5%, 7.6%, 10.8%, and 12.3% respectively. All the risk scores showed a stepwise increase in the risk of death throughout the scoring system of each of the scores and all 4 scores identified patients at greater risk of mortality. The scores were significantly associated with all-cause mortality throughout the follow-up period. PACE displayed the lowest c-index value regardless of whether the population had heart disease of ischemic (c-statistic = 0.61) or nonischemic origin (c-statistic = 0.61), whereas MADIT-II (c-statistic = 0.67 and 0.65 in ischemic and nonischemic cardiomyopathy, respectively), SHOCKED (c-statistic = 0.68 and 0.66, respectively), and FADES (c-statistic = 0.66 and 0.60) provided similar c-statistic values (P ≥ .09).

Conclusions

In this nontrial-based cohort of Mediterranean patients, the 4 evaluated risk scores showed a significant stepwise increase in the risk of death. Among the currently available risk scores, MADIT-II, FADES, and SHOCKED provide slightly better performance than PACE.