Cardiovascular Disease Unit, Policlinic Hospital San Martino IRCCS & Department of Internal Medicine, University of Genova, Genova, Italy.
ANMCO Research Centre, Florence, Fondazione per il Tuo cuore - HCF onluse, Florence, Italy.
Am Heart J. 2019 Feb;208:100-109. doi: 10.1016/j.ahj.2018.11.009. Epub 2018 Nov 24.
The impact of incident sudden cardiac death (SCD) on the predictive accuracy of prognostic risk scores for patients with chronic heart failure (HF) has rarely been examined. We assessed the relationship between estimated probability of death and modes of death in this population, as well as the predictors of death and survival in prognostic outliers.
The MAGGIC 3-year probability of death was estimated in 6,859 participants of the GISSI-HF trial (mean age 67±11 years, 78% men, 91% with ejection fraction <40%, mean follow-up 3.5±1.3 years, observed mortality 28.4%). The incidence of SCD progressively decreased with increased probability of death, and occurred in 52.5% of patients estimated at low-risk (N = 61 with probability <14%) vs. in 23.5% of the high-risk ones (N = 375 with probability >56%, P < .0001). On the contrary, death from worsening HF was significantly more frequent in the latter group (19.7% vs. 46.1%, P < .0001). The overall predictive accuracy of the MAGGIC model improved after excluding deaths from SCD (AUC from 0.731 to 0.760, P = .0034). Among patients estimated at low-risk (N = 61 dead, 743 alive), independent predictors of death were older age, longer history of HF, higher serum uric acid and chronic obstructive pulmonary disease. The only predictor of survival in patients estimated at high-risk (N = 210 alive, 375 dead) was higher systolic blood pressure.
The MAGGIC risk score demonstrated its scarce ability to capture SCD, particularly in chronic HF patients estimated at low risk of death. Newer and better prognostic tools in the evolving horizon of HF are needed.
偶发的心脏性猝死（SCD）对慢性心力衰竭（HF）患者预后风险评分的预测准确性的影响很少被研究。我们评估了该人群中死亡估计概率与死亡方式之间的关系，以及预后异常值中死亡和生存的预测因素。
在 GISSI-HF 试验的 6859 名参与者中估计了 MAGGIC 3 年死亡率（平均年龄 67±11 岁，78%男性，91%射血分数<40%，平均随访 3.5±1.3 年，观察死亡率 28.4%）。SCD 的发生率随着死亡概率的增加而逐渐降低，在低危组（概率<14%，N=61）中发生 52.5%，而在高危组（概率>56%，N=375）中发生 23.5%，差异有统计学意义（P<0.0001）。相反，后者组因 HF 恶化而死亡的比例显著更高（19.7% vs. 46.1%，P<0.0001）。排除 SCD 死亡后，MAGGIC 模型的整体预测准确性提高（AUC 从 0.731 提高到 0.760，P=0.0034）。在低危组（N=61 例死亡，743 例存活）中，死亡的独立预测因素为年龄较大、HF 病史较长、血尿酸和慢性阻塞性肺疾病较高。高危组（N=210 例存活，375 例死亡）中唯一的生存预测因素是较高的收缩压。
MAGGIC 风险评分显示其捕捉 SCD 的能力较差，尤其是在死亡风险低的慢性 HF 患者中。在 HF 的不断发展的前景中，需要新的、更好的预后工具。
