Canepa Marco, Palmisano Pietro, Dell'Era Gabriele, Ziacchi Matteo, Ammendola Ernesto, Accogli Michele, Occhetta Eraldo, Biffi Mauro, Nigro Gerardo, Ameri Pietro, Stronati Giulia, Porto Italo, Dello Russo Antonio, Guerra Federico
Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular Network, 16100 Genova, Italy.
Department of Internal Medicine, University of Genova, 16100 Genova, Italy.
J Clin Med. 2021 Dec 27;11(1):121. doi: 10.3390/jcm11010121.
The role of prognostic risk scores in predicting the competing risk of non-sudden death in heart failure patients with reduced ejection fraction (HFrEF) receiving an implantable cardioverter-defibrillator (ICD) is unclear. To this goal, we evaluated the accuracy and usefulness of the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score. The present analysis included 1089 HFrEF ICD recipients enrolled in the OBSERVO-ICD registry (NCT02735811). During a median follow-up of 36 months (1st-3rd IQR 25-48 months), 193 patients (17.7%) experienced at least one appropriate ICD therapy, and 133 patients died (12.2%) without experiencing any ICD therapy. The frequency of patients receiving ICD therapies was stable around 17-19% across increasing tertiles of 3-year MAGGIC probability of death, whereas non-sudden mortality increased (6.4% to 9.8% to 20.8%, < 0.0001). Accuracy of MAGGIC score was 0.60 (95% CI, 0.56-0.64) for the overall outcome, 0.53 (95% CI, 0.49-0.57) for ICD therapies and 0.65 (95% CI, 0.60-0.70) for non-sudden death. In patients with higher 3-year MAGGIC probability of death, the increase in the competing risk of non-sudden death during follow-up was greater than that of receiving an appropriate ICD therapy. Results were unaffected when analysis was limited to ICD shocks only. The MAGGIC risk score proved accurate and useful in predicting the competing risk of non-sudden death in HFrEF ICD recipients. Estimation of mortality risk should be taken into greater consideration at the time of ICD implantation.
射血分数降低的心力衰竭（HFrEF）患者接受植入式心律转复除颤器（ICD）治疗时，预后风险评分在预测非猝死的竞争风险中的作用尚不清楚。为了实现这一目标，我们评估了慢性心力衰竭Meta分析全球组（MAGGIC）评分的准确性和实用性。本分析纳入了1089名参与OBSERVO-ICD注册研究（NCT02735811）的HFrEF ICD植入患者。在中位随访36个月期间（第1-3四分位数间距为25-48个月），193名患者（17.7%）经历了至少一次ICD恰当治疗，133名患者（12.2%）未经历任何ICD治疗而死亡。在3年MAGGIC死亡概率不断增加的三分位数分组中，接受ICD治疗的患者频率稳定在17%-19%左右，而非猝死死亡率增加（6.4%至9.8%至20.8%，<0.0001）。MAGGIC评分对总体结局的准确性为0.60（95%CI，0.56-0.64），对ICD治疗为0.53（95%CI，0.49-0.57），对非猝死为0.65（95%CI，0.60-0.70）。在3年MAGGIC死亡概率较高的患者中，随访期间非猝死竞争风险的增加大于接受恰当ICD治疗的风险增加。当分析仅限于ICD电击时，结果不受影响。MAGGIC风险评分在预测HFrEF ICD植入患者的非猝死竞争风险方面被证明是准确且有用的。在植入ICD时应更充分地考虑死亡风险评估。
