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Título: | Predicting sudden cardiac death in adults with congenital heart disease |
Autor: | Oliver Ruiz, José María; Gallego, Pastora; González, Ana Elvira; Ávila, Pablo; Alonso, Andrés CSIC ORCID CVN; García-Hamilton, Diego; Peinado, Rafael; Dos Subirá, Laura; Pijuán-Domenech, Antonia; Rueda, Joaquín; Rodríguez-Puras, María José; García-Orta, Rocío; Martínez-Quintana, Efrén; Datino, Tomas; Fernández-Avilés, Francisco; Bermejo, Javier | Fecha de publicación: | 2021 | Editor: | BMJ Publishing Group | Citación: | Heart 107: 67-75 (2021) | Resumen: | [Objectives] To develop, calibrate, test and validate a logistic regression model for accurate risk prediction of sudden cardiac death (SCD) and non-fatal sudden cardiac arrest (SCA) in adults with congenital heart disease (ACHD), based on baseline lesion-specific risk stratification and individual’s characteristics, to guide primary prevention strategies. [Methods] We combined data from a single-centre cohort of 3311 consecutive ACHD patients (50% male) at 25-year follow-up with 71 events (53 SCD and 18 non-fatal SCA) and a multicentre case–control group with 207 cases (110 SCD and 97 non-fatal SCA) and 2287 consecutive controls (50% males). Cumulative incidences of events up to 20 years for specific lesions were determined in the prospective cohort. Risk model and its 5-year risk predictions were derived by logistic regression modelling, using separate development (18 centres: 144 cases and 1501 controls) and validation (two centres: 63 cases and 786 controls) datasets. [Results] According to the combined SCD/SCA cumulative 20 years incidence, a lesion-specific stratification into four clusters—very-low (<1%), low (1%–4%), moderate (4%–12%) and high (>12%)—was built. Multivariable predictors were lesion-specific cluster, young age, male sex, unexplained syncope, ischaemic heart disease, non-life threatening ventricular arrhythmias, QRS duration and ventricular systolic dysfunction or hypertrophy. The model very accurately discriminated (C-index 0.91; 95% CI 0.88 to 0.94) and calibrated (p=0.3 for observed vs expected proportions) in the validation dataset. Compared with current guidelines approach, sensitivity increases 29% with less than 1% change in specificity. [Conclusions] Predicting the risk of SCD/SCA in ACHD can be significantly improved using a baseline lesion-specific stratification and simple clinical variables. |
Versión del editor: | http://dx.doi.org/10.1136/heartjnl-2020-316791 | URI: | http://hdl.handle.net/10261/265155 | DOI: | 10.1136/heartjnl-2020-316791 | Identificadores: | doi: 10.1136/heartjnl-2020-316791 issn: 1355-6037 e-issn: 1468-201X |
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