Department of Cardiology, University Hospital Motol, Second Medical School, Charles University, Prague, Czech Republic.
Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
Am J Cardiol. 2022 Dec 1;184:120-126. doi: 10.1016/j.amjcard.2022.08.028. Epub 2022 Oct 1.
This study aimed to derive a new score, the Alcohol Septal Ablation-Sudden Cardiac ARREst (ASA-SCARRE) risk score, that can be easily used to evaluate the risk of sudden cardiac arrest events (sudden cardiac death, resuscitation, or appropriate implantable cardioverter-defibrillator discharge) after alcohol septal ablation (ASA) in patients with hypertrophic obstructive cardiomyopathy. We analyzed 1,834 patients from the Euro-ASA registry (49% men, mean age 57 ± 14 years) who were followed up for 5.0 ± 4.3 years (9,202 patient-years) after ASA. A total of 65 patients (3.5%) experienced sudden cardiac arrest events, translating to 0.72 events per 100 patient-years. The independent predictors of sudden cardiac arrest events were septum thickness before ASA (hazard ratio 1.09 per 1 mm, 95% confidence interval 1.04 to 1.14, p <0.001) and left ventricular outflow tract (LVOT) gradient at the last clinical checkup (hazard ratio 1.01 per 1 mm Hg, 95% confidence interval 1.01 to 1.02, p = 0.002). The following ASA-SCARRE risk scores were derived and independently predicted long-term risk of sudden cardiac arrest events: "0" for both LVOT gradient <30 mmHg and baseline septum thickness <20 mm; "1" for LVOT gradient ≥30 mm Hg or baseline septum thickness ≥20 mm; and "2" for both LVOT gradient ≥30 mm Hg and baseline septum thickness ≥20 mm. The C statistic of the ASA-SCARRE risk score was 0.684 (SE 0.030). In conclusion, the ASA-SCARRE risk score may be a useful and easily available clinical tool to predict risk of sudden cardiac arrest events after ASA in patients with hypertrophic obstructive cardiomyopathy.
本研究旨在制定一个新的评分系统，即酒精室间隔消融-心脏骤停风险评分（ASA-SCARRE），以评估肥厚型梗阻性心肌病患者接受酒精室间隔消融（ASA）后发生心脏性猝死、复苏或恰当的植入式心律转复除颤器放电等心脏骤停事件的风险。我们分析了来自欧洲 ASA 注册中心的 1834 例患者（49%为男性，平均年龄 57±14 岁），这些患者在接受 ASA 治疗后随访了 5.0±4.3 年（9202 患者-年）。共有 65 例患者（3.5%）发生了心脏骤停事件，换算为每 100 例患者-年发生 0.72 例。心脏骤停事件的独立预测因素包括 ASA 前室间隔厚度（风险比为每 1mm 增加 1.09，95%置信区间为 1.04 至 1.14，p<0.001）和最后一次临床检查时左心室流出道（LVOT）梯度（风险比为每 1mmHg 增加 1.01，95%置信区间为 1.01 至 1.02，p=0.002）。以下是根据 ASA-SCARRE 风险评分衍生的独立预测长期心脏骤停事件风险的评分：LVOT 梯度<30mmHg 且基线室间隔厚度<20mm 为“0”；LVOT 梯度≥30mmHg 或基线室间隔厚度≥20mm 为“1”；LVOT 梯度≥30mmHg 且基线室间隔厚度≥20mm 为“2”。ASA-SCARRE 风险评分的 C 统计量为 0.684（SE 0.030）。总之，ASA-SCARRE 风险评分可能是一种有用且易于获得的临床工具，可用于预测肥厚型梗阻性心肌病患者接受 ASA 治疗后发生心脏骤停事件的风险。
