The ZAHARA risk score outperformed CARPREG I at predicting adverse cardiovascular outcomes in pregnant women with congenital heart disease (AUC 0.80 vs 0.72, P=0.03).
Observational (n=178)
No
Do risk stratification schemes (CARPREG I, ZAHARA, modified WHO) accurately predict adverse cardiac outcomes compared to clinical factors alone in pregnant women with congenital heart disease?
Clinical factors alone predict adverse cardiac events comparably to established risk scores like ZAHARA in pregnant women with congenital heart disease, while CARPREG I and ZAHARA underestimate risk in lower-risk pregnancies.
Effect estimate: AUC 0.80 vs 0.72
p-value: p=0.03
OBJECTIVE: To assess performance of risk stratification schemes in predicting adverse cardiac outcomes in pregnant women with congenital heart disease (CHD) and to compare these schemes to clinical factors alone. DESIGN: Single-center retrospective study. SETTING: Tertiary care academic hospital. PATIENTS: Women ≥18 years with International Classification of Diseases, Ninth Revision, Clinical Modification codes indicating CHD who delivered between 1998 and 2014. CARPREG I and ZAHARA risk scores and modified World Health Organization (WHO) criteria were applied to each woman. OUTCOME MEASURES: The primary outcome was defined by ≥1 of the following: arrhythmia, heart failure/pulmonary edema, transient ischemic attack, stroke, dissection, myocardial infarction, cardiac arrest, death during gestation and up to 6 months postpartum. RESULTS: Of 178 women, the most common CHD lesions were congenital aortic stenosis (15.2%), ventricular septal defect (13.5%), atrial septal defect (12.9%), and tetralogy of Fallot (12.9%). Thirty-five women (19.7%) sustained 39 cardiac events. Observed vs expected event rates were 9.9% vs 5% (P = .02) for CARPREG I score 0 and 26.1% vs 7.5% (P < .001) for ZAHARA scores 0.51-1.5. ZAHARA outperformed CARPREG I at predicting adverse cardiovascular outcomes (AUC 0.80 vs 0.72, P = .03) but was not significantly better than modified WHO. Clinical predictors of adverse cardiac event were symptoms (P = .002), systemic ventricular dysfunction (P < .001), and subpulmonary ventricular dysfunction (P = .03) with an AUC 0.83 comparable to ZAHARA (P = .66). CONCLUSIONS: CARPREG I and ZAHARA scores underestimate cardiac risk for lower risk pregnancies in these women. Of the three risk schemes, CARPREG I performed least well in predictive capacity. Clinical factors specific to the population studied are comparable to stratification schemes.
Kim et al. (Wed,) conducted a observational in Congenital heart disease in pregnancy (n=178). ZAHARA risk score vs. CARPREG I risk score was evaluated on ≥1 of the following: arrhythmia, heart failure/pulmonary edema, transient ischemic attack, stroke, dissection, myocardial infarction, cardiac arrest, death during gestation and up to 6 months postpartum (AUC 0.80 vs 0.72, p=0.03). The ZAHARA risk score outperformed CARPREG I at predicting adverse cardiovascular outcomes in pregnant women with congenital heart disease (AUC 0.80 vs 0.72, P=0.03).