prevention in HCM [EVIDENCE-HCM] Constantinos OMahony, Fatima Jichi, - - PowerPoint PPT Presentation

An international external validation study of the 2014 ESC guideline on SCD prevention in HCM [EVIDENCE-HCM]

Constantinos O’Mahony, Fatima Jichi, Rumana Omar, Perry Elliott

Declaration of Interest

• No conflict of interest to declare

Background

• Hypertrophic cardiomyopathy (HCM) causes sudden

cardiac death (SCD)

• Prophylactic treatment with implantable cardioverter

defibrillators (ICD) is recommended for those at high risk

• In 2014 the ESC proposed a new approach using a

clinical risk tool (HCM Risk-SCD)

Aims and methods

• Aim: validate the 2014 ESC recommendations
• n SCD prevention
• Observational, retrospective, longitudinal

cohort study

• 14 centres, n=3703 with median FU 5.9 years
• 73 SCD end-points at 5 years

Results

Validation HCMRisk-SCD

Study

.5 .6 .7 .8 .9 1

C-statistic with 95% CI

Validation HCMRisk-SCD

Study

.7 .8 .9 1 1.1 1.2

Calibration with 95% CI

Results

0.00 0.02 0.04 0.06 0.08 0.10 297 265 (9) 248 (3) 227 (6) 218 (2) 188 (3) >=6% 326 299 (1) 271 (1) 242 (3) 223 (0) 198 (0) 4 to <6% 1524 1390 (7) 1249 (1) 1106 (2) 973 (2) 814 (4) <4% Number at risk 1 2 3 4 5 Follow-up (years) <4% 4% to <6% =>6%

Complete case analysis n=2147 patients

SCD endpoints per ESC 2014 recommendation

≥6% 1/13 ≥5% 1/16 ≥4% 1/22

Clinical implications

Conclusions

• 2014 ESC guidelines provide accurate

prognostic information

• The risk-benefit ratio for ICD implantation is

more favourable in individuals with an estimated 5-year risk of ≥6%