Comparison of the new risk prediction model (HCM Risk-SCD) and classic risk factors for sudden death in patients with hypertrophic cardiomyopathy and defibrillator

• Published in: Europace (London, England) England), 2016-05, Vol.18 (5), p.773-777
• Main Authors: Ruiz-Salas, Amalio, García-Pinilla, Jose Manuel, Cabrera-Bueno, Fernando, Fernández-Pastor, Julia, Peña-Hernández, José, Medina-Palomo, Carmen, Barrera-Cordero, Alberto, De Teresa, Eduardo, Alzueta, Javier
• Format: Article
• Language: English
• Subjects: Adult; Arrhythmias, Cardiac - epidemiology; Arrhythmias, Cardiac - prevention & control; Cardiomyopathy, Hypertrophic - complications; Cardiomyopathy, Hypertrophic - therapy; Death, Sudden, Cardiac - epidemiology; Death, Sudden, Cardiac - prevention & control; Defibrillators, Implantable; Female; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Middle Aged; Odds Ratio; Primary Prevention - methods; Retrospective Studies; Risk Factors; Spain
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euv079

Hypertrophic cardiomyopathy is one of the main causes of sudden death in young people. Recent clinical practice guidelines include a risk prediction model for sudden death (HCM Risk-SCD), which facilitates the decision of whether to implant a defibrillator. The aim of our study was to ascertain the percentage of events in our series of primary prevention implantable cardioverter-defibrillator recipients with hypertrophic cardiomyopathy and whether HCM Risk-SCD predicts the onset of arrhythmic events. This was an observational, retrospective cohort study, which included 48 primary prevention defibrillator recipient patients with HCM. We compiled their demographic and clinical characteristics, estimated 5-year risk using HCM Risk-SCD, and collected the documentation on arrhythmias during follow-up. The majority was male (66.7%) and mean age at implantation was 44.44 ± 14.46 years. Non-sustained ventricular tachycardia was the most prevalent risk factor (66.67%), followed by a family history of sudden death (47.92%). Mean HCM Risk-SCD was 6.15 ± 5.01%. HCM Risk-SCD was the only factor independently associated with the onset of ventricular tachyarrhythmia, above any other classic risk factor or association [odds ratio = 1.46 (95% confidence interval 1.051-2.013); P = 0.02]. None of the 11 patients estimated as low risk using HCM Risk-SCD suffered any appropriate events (P < 0.05). During an average follow-up of 4 years, 16.67% presented appropriate events (4.16%/year). HCM Risk-SCD predicted the onset of events more suitably than classic risk factors.