Key result
2020 AHA/ACC SCD risk stratification outperforms older guidelines in Chinese HCM patients with 0.71 AUC.
Why the study?
Identifying patients at high risk of sudden cardiac death in hypertrophic cardiomyopathy is challenging, and the 2011 ACCF/AHA, 2014 ESC, and 2020 AHA/ACC risk stratifications needed validation in Chinese patients.
Does the 2020 AHA/ACC guideline SCD risk stratification better predict SCD events compared to the 2011 ACCF/AHA and 2014 ESC guidelines in Chinese patients with HCM?
Cohort (n=511)
No
Does the 2020 AHA/ACC guideline SCD risk stratification better predict SCD events compared to the 2011 ACCF/AHA and 2014 ESC guidelines in Chinese patients with HCM?
Effect estimate: AUC 0.71 (95% CI 0.56-0.87)
p-value: p=<0.001
The 2020 AHA/ACC SCD risk stratification model provides better discrimination for sudden cardiac death in Chinese patients with HCM compared to previous 2011 ACCF/AHA and 2014 ESC models.
May improve SCD risk stratification in Chinese HCM patients; leaves open need for prospective validation before practice change.
Background: Sudden cardiac death (SCD) is a common cause of death in hypertrophic cardiomyopathy (HCM), but identification of patients at a high risk of SCD is challenging. The study aimed to validate the three SCD risk stratifications recommended by the 2011 ACCF/AHA guideline, the 2014 ESC guideline, and the 2020 AHA/ACC guideline in Chinese HCM patients. Methods: The study population consisted of a consecutive cohort of 511 patients with HCM without a history of SCD event. The endpoint was a composite of SCD or an equivalent event (appropriate implantable cardioverter defibrillator therapy or successful resuscitation after cardiac arrest). Results: During a follow-up of 4.7 ± 1.7 years, 15 patients (2.9%) reached the SCD endpoint and 12 (2.3%) were protected by implantable cardioverter defibrillator for primary prevention. A total of 13 (2.8%) patients experiencing SCD events were misclassified as low-risk patients by the 2011 ACCF/AHA guideline, 12 (2.3%) by the 2014 ESC model, and 7 (1.6%) by the 2020 AHA/ACC guideline. The SCD risk stratification in the 2020 AHA/ACC guideline showed greater area under the curve (0.71; 95% CI 0.56–0.87, p < 0.001) than the one in the 2011 ACCF/AHA guideline (0.52; 95% CI 0.37–0.67, p = 0.76) and 2014 ESC guideline (0.68; 95% CI 0.54–0.81, p = 0.02). Conclusion: The SCD risk stratification recommended by the 2020 AHA/ACC guideline showed a better discrimination than previous stratifications in Chinese patients with HCM. A larger multicenter, independent, and prospective study with long-term follow-up would be warranted to validate our result.
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Dong et al. (2021) conducted a cohort in Hypertrophic cardiomyopathy (n=511). 2020 AHA/ACC guideline SCD risk stratification vs. 2011 ACCF/AHA and 2014 ESC guideline SCD risk stratifications was evaluated on Composite of SCD or an equivalent event (appropriate implantable cardioverter defibrillator therapy or successful resuscitation after cardiac arrest) (AUC 0.71, 95% CI 0.56-0.87, p=<0.001). The 2020 AHA/ACC guideline sudden cardiac death risk stratification showed better discrimination (AUC 0.71; 95% CI 0.56-0.87) than the 2011 ACCF/AHA and 2014 ESC guidelines in Chinese HCM patients.
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