Key result
Four-factor risk score predicts 5-year VA/SCD in Brugada syndrome with ~80% specificity.
Why the study?
Risk stratification in Brugada syndrome is challenging due to low event rates and conflicting evidence regarding predictors of ventricular arrhythmias and sudden cardiac death.
Can a clinical risk score model predict ventricular arrhythmias or sudden cardiac death in primary prevention patients with Brugada syndrome?
Cohort (n=1,110)
Yes
Can a clinical risk score model predict ventricular arrhythmias or sudden cardiac death in primary prevention patients with Brugada syndrome?
A novel risk score model incorporating four clinical and ECG factors can effectively predict the risk of ventricular arrhythmias and sudden cardiac death in primary prevention patients with Brugada syndrome.
May support risk stratification in Brugada syndrome but should not yet change practice; leaves open prospective validation.
OBJECTIVES: The goal of this study was to develop a risk score model for patients with Brugada syndrome (BrS). BACKGROUND: Risk stratification in BrS is a significant challenge due to the low event rates and conflicting evidence. METHODS: A multicenter international cohort of patients with BrS and no previous cardiac arrest was used to evaluate the role of 16 proposed clinical or electrocardiogram (ECG) markers in predicting ventricular arrhythmias (VAs)/sudden cardiac death (SCD) during follow-up. Predictive markers were incorporated into a risk score model, and this model was validated by using out-of-sample cross-validation. RESULTS: A total of 1,110 patients with BrS from 16 centers in 8 countries were included (mean age 51.8 ± 13.6 years; 71.8% male). Median follow-up was 5.33 years; 114 patients had VA/SCD (10.3%) with an annual event rate of 1.5%. Of the 16 proposed risk factors, probable arrhythmia-related syncope (hazard ratio [HR]: 3.71; p < 0.001), spontaneous type 1 ECG (HR: 3.80; p < 0.001), early repolarization (HR: 3.42; p < 0.001), and a type 1 Brugada ECG pattern in peripheral leads (HR: 2.33; p < 0.001) were associated with a higher risk of VA/SCD. A risk score model incorporating these factors revealed a sensitivity of 71.2% (95% confidence interval: 61.5% to 84.6%) and a specificity of 80.2% (95% confidence interval: 75.7% to 82.3%) in predicting VA/SCD at 5 years. Calibration plots showed a mean prediction error of 1.2%. The model was effectively validated by using out-of-sample cross-validation according to country. CONCLUSIONS: This multicenter study identified 4 risk factors for VA/SCD in a primary prevention BrS population. A risk score model was generated to quantify risk of VA/SCD in BrS and inform implantable cardioverter-defibrillator prescription.
No takes yet. Share an insight, caveat, or question.
Honarbakhsh et al. (2020) conducted a cohort in Brugada syndrome (n=1,110). Clinical risk score model (BRUGADA-RISK) was evaluated on Ventricular arrhythmias (VAs)/sudden cardiac death (SCD). A 4-factor clinical risk score model predicted ventricular arrhythmias or sudden cardiac death at 5 years in Brugada syndrome patients with 71.2% sensitivity and 80.2% specificity.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: