ESC risk model reduces ICD use in hypertrophic cardiomyopathy
High-risk patients with hypertrophic cardiomyopathy would not have been protected from sudden death through the recommendation of an implantable cardioverter defibrillator using the European Society of Cardiology risk scoring model compared with U.S. guidelines, according to a study published in The American Journal of Cardiology.
Kevin M. W. Leong, MRCP, research postgraduate at the National Heart and Lung Institute at Imperial College in London, and colleagues reviewed data from 288 patients (mean age, 52 years; 66% men) with hypertrophic cardiomyopathy who did (n = 14; mean age, 41 years; 71% men) or did not (n = 274; mean age, 53 years; 66% men) have previously aborted sudden cardiac death or equivalent events. Patients with left ventricular hypertrophy that was associated with amyloidosis, Fabry disease, congenital heart defects or mitochondrial disease were excluded.
The following risk scores and recommendations for an ICD implant were compared: 2014 ESC risk scoring model, 2011 American College of Cardiology Foundation/American Heart Association guidelines and 2003 ACCF/AHA guidelines.
The endpoint of interest was sudden cardiac death or an equivalent event. Follow-up was conducted until the endpoint was reached or Oct. 1, 2016.
In patients with previous sudden cardiac death, 43% would not have met the criteria for an ICD implant with the ESC risk scoring model compared with 7% of patients using either version of the ACCF/AHA guidelines (P = .029).
More patients without sudden cardiac death would not have required an ICD with the ESC risk scoring model (82%) compared with the ACCF/AHA guidelines (57%; P < .0001).
Five patients who experienced sudden cardiac death would have not been recommended an ICD with the ESC risk model compared with the 2011 ACCF/AHA guidelines.
“Ultimately, the ESC scoring system appears to have a higher C-index score because of its greater specificity in our cohort of patients,” Leong and colleagues wrote. “However, this may be at the cost of reduced sensitivity and, thus, missed opportunity to offer appropriate ICD therapy. In the end, either risk scoring system will provide an estimate of risk for the individual, which provides a useful anchor to base a discussion on the perceived risk and benefits of an ICD. However, an appreciation of the limitations of any risk scoring system is essential so that clinicians understand the potential implications of the quantitative measure of risk that is assigned.” – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures.