The Inherited Cardiac Diseases Unit, Barts Heart Centre, St Bartholomew's Hospital, London, UK.
UCL Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK.
Heart. 2019 Apr;105(8):623-631. doi: 10.1136/heartjnl-2018-313700. Epub 2018 Oct 26.
In 2014, the European Society of Cardiology (ESC) recommended the use of a novel risk prediction model (HCM Risk-SCD) to guide use of implantable cardioverter defibrillators (ICD) for the primary prevention of sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM). We sought to determine the performance of HCM Risk-SCD by conducting a systematic review and meta-analysis of articles reporting on the prevalence of SCD within 5 years of evaluation in low, intermediate and high-risk patients as defined by the 2014 guidelines (predicted risk <4%, 4%-<6% and ≥6%, respectively).
The protocol was registered with PROSPERO (registration number: CRD42017064203). MEDLINE and manual searches for papers published from October 2014 to December 2017 were performed. Longitudinal, observational cohorts of unselected adult patients, without history of cardiac arrest were considered. The original HCM Risk-SCD development study was included a priori. Data were pooled using a random effects model.
Six (0.9%) out of 653 independent publications identified by the initial search were included. The calculated 5-year risk of SCD was reported in 7291 individuals (70% low, 15% intermediate; 15% high risk) with 184 (2.5%) SCD endpoints within 5 years of baseline evaluation. Most SCD endpoints (68%) occurred in patients with an estimated 5-year risk of ≥4% who formed 30% of the total study cohort. Using the random effects method, the pooled prevalence of SCD endpoints was 1.01% (95% CI 0.52 to 1.61) in low-risk patients, 2.43% (95% CI 1.23 to 3.92) in intermediate and 8.4% (95% CI 6.68 to 10.25) in high-risk patients.
This meta-analysis demonstrates that HCM Risk-SCD provides accurate risk estimations that can be used to guide ICD therapy in accordance with the 2014 ESC guidelines.
PROSPERO CRD42017064203;Pre-results.
2014 年，欧洲心脏病学会（ESC）推荐使用一种新的风险预测模型（HCM Risk-SCD）来指导植入式心脏复律除颤器（ICD）在肥厚型心肌病（HCM）患者中的应用，以预防心脏性猝死（SCD）。我们通过对 2014 年指南（预测风险<4%、4%-<6%和≥6%）中低、中、高风险患者（分别为<4%、4%-<6%和≥6%）在评估后 5 年内 SCD 发生率的研究进行系统回顾和荟萃分析，旨在确定 HCM Risk-SCD 的性能。
该方案已在 PROSPERO（注册号：CRD42017064203）中注册。检索了 2014 年 10 月至 2017 年 12 月发表的 MEDLINE 和手工文献，纳入了未经选择的成年患者的纵向观察队列，且患者均无心脏骤停病史。预先纳入了原始的 HCM Risk-SCD 开发研究。使用随机效应模型对数据进行汇总。
初始搜索确定的 653 篇独立文献中，有 6 篇（0.9%）入选。在 7291 名患者中报告了 5 年 SCD 风险，其中 184 名（2.5%）患者在基线评估后 5 年内出现 SCD 终点事件。大多数 SCD 终点事件（68%）发生在估计 5 年风险≥4%的患者中，这些患者占总研究队列的 30%。使用随机效应法，低危患者的 SCD 终点发生率为 1.01%（95% CI 0.52%1.61%），中危患者为 2.43%（95% CI 1.23%3.92%），高危患者为 8.4%（95% CI 6.68%~10.25%）。
这项荟萃分析表明，HCM Risk-SCD 可提供准确的风险评估，可根据 2014 年 ESC 指南指导 ICD 治疗。
PROSPERO CRD42017064203；预注册结果。
