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 on 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 HCMRisk-SCD HCMRisk-SCD Study Study Validation Validation .5 .6 .7 .8 .9 1 .7 .8 .9 1 1.1 1.2 C-statistic with 95% CI Calibration with 95% CI
Results SCD endpoints per ESC 2014 recommendation 0.10 0.08 0.06 0.04 0.02 0.00 0 1 2 3 4 5 Follow-up (years) Number at risk <4% 1524 (7) 1390 (1) 1249 (2) 1106 (2) 973 (4) 814 4 to <6% 326 (1) 299 (1) 271 (3) 242 (0) 223 (0) 198 >=6% 297 (9) 265 (3) 248 (6) 227 (2) 218 (3) 188 <4% 4% to <6% =>6% Complete case analysis n=2147 patients
Clinical implications ≥6% 1/13 ≥5% 1/16 ≥4% 1/22
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%
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