Accuracy of risk prediction scores in pregnant women with congenital heart disease. (6th February 2019)

• Record Type: Journal Article
• Authors: Kim, Yuli Y.; Goldberg, Leah A.; Awh, Katherine; Bhamare, Tanmay; Drajpuch, David; Hirshberg, Adi; Partington, Sara L.; Rogers, Rachel; Ruckdeschel, Emily; Tobin, Lynda; Venuti, Morgan; Levine, Lisa D.
• Is Part Of: Congenital heart disease. Volume 14:Number 3(2019)
• Page Start: 470
• Page End: 478
• Publication Date: 2019-02-06
• Subjects: adult congenital heart disease -- outcomes -- pregnancy -- risk stratification; Congenital heart disease -- Periodicals; 616.1204305
• DOI: 10.1111/chd.12750
• Languages: English
• ISSNs: 1747-079X

Abstract

Abstract: Objective: To assess performance of risk stratification schemes in predicting adverse cardiac outcomes in pregnant women with congenital heart disease (CHD) and to compare these schemes to clinical factors alone. Design: Single‐center retrospective study. Setting: Tertiary care academic hospital. Patients: Women ≥18 years with International Classification of Diseases, Ninth Revision, Clinical Modification codes indicating CHD who delivered between 1998 and 2014. CARPREG I and ZAHARA risk scores and modified World Health Organization (WHO) criteria were applied to each woman. Outcome Measures: The primary outcome was defined by ≥1 of the following: arrhythmia, heart failure/pulmonary edema, transient ischemic attack, stroke, dissection, myocardial infarction, cardiac arrest, death during gestation and up to 6 months postpartum. Results: Of 178 women, the most common CHD lesions were congenital aortic stenosis (15.2%), ventricular septal defect (13.5%), atrial septal defect (12.9%), and tetralogy of Fallot (12.9%). Thirty‐five women (19.7%) sustained 39 cardiac events. Observed vs expected event rates were 9.9% vs 5% ( P = .02) for CARPREG I score 0 and 26.1% vs 7.5% ( P < .001) for ZAHARA scores 0.51‐1.5. ZAHARA outperformed CARPREG I at predicting adverse cardiovascular outcomes (AUC 0.80 vs 0.72, P = .03) but was not significantly better than modified WHO. Clinical predictors of adverse cardiac event were symptoms ( P = .002), systemic ventricular dysfunction ( P < .001), and subpulmonary ventricular dysfunction ( P = .03) with an AUC 0.83 comparable to ZAHARA ( P = .66). Conclusions: CARPREG I and ZAHARA scores underestimate cardiac risk for lower risk pregnancies in these women. Of the three risk schemes, CARPREG I performed least well in predictive capacity. Clinical factors specific to the population studied are comparable to stratification schemes.