Development of a risk score for patients with ischaemic cardiomyopathy

Background: Ischaemic cardiomyopathy is a leading cause of heart failure and is associated with a poor prognosis.Aim: To evaluate predictors of major adverse cardiovascular events (MACE) and to develop a risk score for the disease.Methods: All patients with ischaemic cardiomyopathy referred to a tertiary hospital between 2010 and 2018 for stress-rest gated single-photon emission computed tomography (SPECT) were included retro-spectively (n = 747). Clinical and gated SPECT-derived variables were analysed as predictors of MACE, a combined endpoint of cardiovascular mortality, heart failure hospitalization or myocardial infarction during follow-up. A multivariable Cox model using backwards stepwise regression with competing risks was used to select the best parsimonious model.Results: After a median follow-up of 4.7 years, 313 patients had MACE (41.9%). Independent predictors of MACE were previous heart failure admission, worsening angina or dyspnoea, estimated glomeru-lar filtration rate <= 60 mL/min/1.73 m2, age > 73 years, diabetes, atrial fibrillation, end-diastolic volume index > 83 mL/m2 and > 12% of scarred myocardium. A risk score ranging from 0 to 12 classified patients as at intermediate risk (event rate of 4.0 MACE per 100 person-years), high risk (11.3 MACE per 100 person-years) or very high risk (27.8 MACE per 100 person-years). The internally validated area under the curve was 0.720 (95% confidence interval 0.660-0.740) and calibration was adequate (Hosmer-Lemeshow test P= 0.28) for MACE.Conclusions: In patients with ischaemic cardiomyopathy, a simple risk score using dichotomic and readily available variables obtained from clinical assessment and gated SPECT accurately predicts the risk of MACE.(c) 2023 Elsevier Masson SAS. All rights reserved.