A bio-clinical approach for prediction of sudden cardiac death in outpatients with heart failure: The ST2-SCD score. (15th October 2019)

• Record Type: Journal Article
• Authors: Lupón, Josep; Cediel, Germán; Moliner, Pedro; de Antonio, Marta; Domingo, Mar; Zamora, Elisabet; Núñez, Julio; González, Beatriz; Santiago-Vacas, Evelyn; Santesmases, Javier; Troya, Maria Isabel; Díez-Quevedo, Crisanto; Boldó, Maria; Barallat, Jaume; Bayes-Genis, Antoni
• Is Part Of: International journal of cardiology. Volume 293(2019)
• Page Start: 148
• Page End: 152
• Publication Date: 2019-10-15
• Subjects: HF heart failure -- SCD sudden cardiac death -- LVEF left ventricular ejection fraction -- ICD implantable cardiac defibrillator -- hs-TnT high-sensitivity troponin T -- NT-proBNP N-terminal pro-brain natriuretic peptide -- ST2 interleukin-1 receptor-like 1; Heart failure -- Sudden death -- Biomarkers -- Risk prediction -- Survival; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2019.05.046
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Sudden cardiac death (SCD) is one of the main modes of death in heart failure (HF) patients and its prediction remains a real challenge. Our aim was to assess the incidence of SCD at 5 years HF contemporary managed outpatients, and to find a simple prediction model for SCD. Methods: SCD was considered any unexpected death, witnessed or not, occurring in a previously stable patient with no evidence of worsening HF or any other cause of death. A competing risk strategy was adopted using the Fine-Gray method of Cox regressions analyses that considered other causes of death as the competing event. Results: The derivation cohort included 744 consecutive outpatients (72% men, age 67.9 ± 12.2 years, left ventricular ejection fraction [LVEF] 36% ± 14). During follow-up, 312 deaths occurred, 40 SCDs (5.4%). Age, haemoglobin, eGFR, HF duration, high-sensitivity troponin T, NTproBNP, and ST2 were associated with SCD in univariate analyses; HF duration ( p = 0.006), eGFR ( p < 0.001), LVEF <45% ( p = 0.03), and ST2 (p = 0.006) remained in multivariable analysis. A predictive score (ST2-SCD) including dichotomous variables (ST2 > 45, LVEF <45%, HF duration >3 years, eGFR < 55, age ≥ 60 years and male sex) provided a Harrell's C-statistic of 0.82 (0.76-0.89)), reaching 0.87 (0.80–0.95) in the validation cohort ( n = 149). Conclusions: In contemporary managed HF, SCD occurred in 5.4% of outpatients, accounting for 12.8% of all deaths at 5 years. Of the 3 studied biomarkers, only ST2 remained independently associated with SCD. A model containing age, sex, ST2, eGFR, LVEF, and HF duration reasonably predicted 5-years risk of SCD. Highlights: SCD remains one of the main modes of death in patients with HF. Prediction of SCD in patients with chronic HF is still a real challenge. Strategies are needed to better identify patients at high risk of suffering SCD. The ST2-SCD score predicted the risk of SCD at 5 years with notable accuracy. The ST2-SCD score might help in refining who would benefit most from an ICD.