Marco Canepa1, Pietro Ameri1, Donata Lucci2, Gian Luigi Nicolosi3, Roberto Marchioli4, Maurizio Porcu5, Gianni Tognoni6, Maria Grazia Franzosi6, Roberto Latini6, Attilio Maseri7, Luigi Tavazzi8, Aldo Pietro Maggioni9. 1. Cardiovascular Disease Unit, Policlinic Hospital San Martino IRCCS & Department of Internal Medicine, University of Genova, Genova, Italy. 2. ANMCO Research Centre, Florence, Fondazione per il Tuo cuore - HCF onluse, Florence, Italy. 3. Department of Cardiology, Santa Maria degli Angeli Hospital, Pordenone, Italy. 4. Therapeutic Science and Strategy Unit (TSSU), IQVIA, Milan, Italy. 5. Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu-San Michele, Cagliari, Italy. 6. Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy. 7. Fondazione per il Tuo cuore - HCF onlus, Florence, Italy. 8. Scientific Direction, Maria Cecilia Hospital, GVM Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy. 9. ANMCO Research Centre, Florence, Fondazione per il Tuo cuore - HCF onluse, Florence, Italy. Electronic address: maggioni@anmco.it.
Abstract
BACKGROUND: The impact of incident sudden cardiac death (SCD) on the predictive accuracy of prognostic risk scores for patients with chronic heart failure (HF) has rarely been examined. We assessed the relationship between estimated probability of death and modes of death in this population, as well as the predictors of death and survival in prognostic outliers. METHODS AND RESULTS: The MAGGIC 3-year probability of death was estimated in 6,859 participants of the GISSI-HF trial (mean age 67±11 years, 78% men, 91% with ejection fraction <40%, mean follow-up 3.5±1.3 years, observed mortality 28.4%). The incidence of SCD progressively decreased with increased probability of death, and occurred in 52.5% of patients estimated at low-risk (N = 61 with probability <14%) vs. in 23.5% of the high-risk ones (N = 375 with probability >56%, P < .0001). On the contrary, death from worsening HF was significantly more frequent in the latter group (19.7% vs. 46.1%, P < .0001). The overall predictive accuracy of the MAGGIC model improved after excluding deaths from SCD (AUC from 0.731 to 0.760, P = .0034). Among patients estimated at low-risk (N = 61 dead, 743 alive), independent predictors of death were older age, longer history of HF, higher serum uric acid and chronic obstructive pulmonary disease. The only predictor of survival in patients estimated at high-risk (N = 210 alive, 375 dead) was higher systolic blood pressure. CONCLUSIONS: The MAGGIC risk score demonstrated its scarce ability to capture SCD, particularly in chronic HF patients estimated at low risk of death. Newer and better prognostic tools in the evolving horizon of HF are needed.
BACKGROUND: The impact of incident sudden cardiac death (SCD) on the predictive accuracy of prognostic risk scores for patients with chronic heart failure (HF) has rarely been examined. We assessed the relationship between estimated probability of death and modes of death in this population, as well as the predictors of death and survival in prognostic outliers. METHODS AND RESULTS: The MAGGIC 3-year probability of death was estimated in 6,859 participants of the GISSI-HF trial (mean age 67±11 years, 78% men, 91% with ejection fraction <40%, mean follow-up 3.5±1.3 years, observed mortality 28.4%). The incidence of SCD progressively decreased with increased probability of death, and occurred in 52.5% of patients estimated at low-risk (N = 61 with probability <14%) vs. in 23.5% of the high-risk ones (N = 375 with probability >56%, P < .0001). On the contrary, death from worsening HF was significantly more frequent in the latter group (19.7% vs. 46.1%, P < .0001). The overall predictive accuracy of the MAGGIC model improved after excluding deaths from SCD (AUC from 0.731 to 0.760, P = .0034). Among patients estimated at low-risk (N = 61 dead, 743 alive), independent predictors of death were older age, longer history of HF, higher serum uric acid and chronic obstructive pulmonary disease. The only predictor of survival in patients estimated at high-risk (N = 210 alive, 375 dead) was higher systolic blood pressure. CONCLUSIONS: The MAGGIC risk score demonstrated its scarce ability to capture SCD, particularly in chronic HF patients estimated at low risk of death. Newer and better prognostic tools in the evolving horizon of HF are needed.
Authors: Lina Miao; Ming Guo; Deng Pan; Pengfei Chen; Zhuhong Chen; Jie Gao; Yanqiao Yu; Dazhuo Shi; Jianpeng Du Journal: Front Med (Lausanne) Date: 2021-12-14