Applicability of the PAINESD risk score for 30-day mortality prediction post ventricular tachycardia catheter ablation in Chagas disease.

Autor: Kulchetscki RM; Instituto do Coração FMUSP, São Paulo, Brazil., Pisani CF; Instituto do Coração FMUSP, São Paulo, Brazil., Alexandre FKB; Instituto do Coração FMUSP, São Paulo, Brazil., Mayrink MP; Instituto do Coração FMUSP, São Paulo, Brazil., Ferraz AP; Instituto do Coração FMUSP, São Paulo, Brazil., Gouvea FC; Instituto do Coração FMUSP, São Paulo, Brazil., Goncalves ALM; Instituto do Coração FMUSP, São Paulo, Brazil., Hardy CA; Instituto do Coração FMUSP, São Paulo, Brazil., Melo SL; Instituto do Coração FMUSP, São Paulo, Brazil., Chokr MO; Instituto do Coração FMUSP, São Paulo, Brazil., Scanavacca MI; Instituto do Coração FMUSP, São Paulo, Brazil. mauricio.scanavacca@incor.usp.br.
Jazyk: angličtina
Zdroj: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing [J Interv Card Electrophysiol] 2021 Dec; Vol. 62 (3), pp. 469-477. Date of Electronic Publication: 2021 May 08.
DOI: 10.1007/s10840-021-00995-z
Abstrakt: Purpose: The PAINESD risk score was developed in 2015 as a tool to stratify the risk of acute hemodynamic decompensation during ventricular tachycardia (VT) ablation in structural heart disease patients and further then used for post procedure 30-day mortality prediction. The original cohort however did not include Chagas disease (ChD) patients. We aim to evaluate the relevance of the score in a ChD population.
Methods: The PAINESD risk score gives weighted values for specific characteristics (chronic obstructive pulmonary disease, age > 60 years, ischemic cardiomyopathy, New York Heart Association [NYHA] functional class 3 or 4, ejection fraction less than 25%, VT storm, and diabetes). The score was applied in a retrospective cohort of ChD VT ablations in a single tertiary center in Brazil. Data were collected by VT study reports and patient record analysis at baseline and on follow-up.
Results: Between January 2013 and December 2018, 157 VT catheter ablation procedures in 121 ChD patients were analyzed. Overall, 30-day mortality was 9.0%. Multivariate analysis correlated NYHA functional class (HR 1.78, 95% CI 1.03-3.08, P 0.038) and the need for urgent surgery (HR 31.5, 95% CI 5.38-184.98, P < 0.001), as well as a tendency for VT storm at presentation (HR 2.72, 95% CI 0.87-8.50, P 0.084) as risk factors for the primary endpoint. The median PAINESD risk score in this population was 3 (3-8). The area under the receiver operating characteristic (ROC) curve was 0.64 (95% CI 0.479-0.814).
Conclusions: The PAINESD risk score did not perform well in predicting 30-day mortality in ChD patients. Pre-procedure NYHA functional class and the need for urgent surgery due to refractory pericardial bleeding were independently associated with increased 30-day mortality. Prospective studies are needed to take final conclusions in Chagas disease when using PAINESD score.
(© 2021. Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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