The HCM Risk-SCD calculator predicted sudden cardiac death or appropriate ICD therapy with a C-statistic of 0.718, but 63.6% of sudden cardiac deaths occurred in the low-risk group.
Cohort (n=730)
Does the 2014 ESC HCM Risk-SCD calculator effectively predict sudden cardiac death and appropriate ICD therapy in a Korean hypertrophic cardiomyopathy population?
The HCM Risk-SCD calculator has good overall accuracy in Korean patients but may misclassify a significant proportion of those who experience sudden cardiac death as low risk, a limitation that can be improved by incorporating sex into the model.
OBJECTIVE: The hypertrophic cardiomyopathy (HCM) risk-sudden cardiac death (SCD) calculator endorsed by the 2014 European Society of Cardiology has not been independently validated in the Asians. We aimed to investigate whether the HCM Risk-SCD calculator effectively predicts SCD in Korean HCM population. METHODS: An observational, longitudinal cohort study was performed in 730 patients with HCM from 2007 to 2017. The primary endpoint was a composite of SCD and appropriate implantable cardioverter-defibrillator (ICD) therapy. RESULTS: During a follow-up period of 4288 person-years, 16 (2.2%) patients reached the primary endpoint. This validation study revealed a calibration slope of 0.892 and C-statistics of 0.718. The primary endpoint occurred in 1.1% (7/615), 4.6% (3/65) and 12.0% (6/50) of low-risk, intermediate-risk and high-risk groups, respectively. Although most patients (85.2%) without the primary endpoint were classified into the low-risk group, 7 of 11 SCD (63.6%) occurred in the low-risk group. In univariable and multivariable analysis, sex (woman) was significantly associated with the primary endpoint and emerged as independent predictor. The addition of sex to the HCM Risk-SCD calculator significantly improved the predictive value of the primary endpoint (net reclassification improvement 0.557, p=0.015). CONCLUSIONS: In the Korean HCM population, the HCM Risk-SCD calculator had a high negative predictive value and accuracy for predicting SCD or appropriate ICD therapy, but misclassified a few patients experiencing the primary endpoint as low-risk or intermediate-risk groups.
Choi et al. (Mon,) conducted a cohort in Hypertrophic cardiomyopathy (n=730). HCM Risk-SCD calculator was evaluated on Composite of sudden cardiac death and appropriate implantable cardioverter-defibrillator therapy. The HCM Risk-SCD calculator predicted sudden cardiac death or appropriate ICD therapy with a C-statistic of 0.718, but 63.6% of sudden cardiac deaths occurred in the low-risk group.