title: Predictive accuracy of three clinical risk assessment systems for cardiac complications among Chinese pregnant women with congenital heart disease.
abstract: OBJECTIVE
  To compare the predictive accuracy of three risk assessment systems for cardiac complications among pregnant women with congenital heart disease (CHD).
  
  
  METHODS
  In a retrospective study, data were assessed from women with CHD at more than 20weeks of pregnancy who attended Shanghai Obstetrical Cardiology Intensive Care Center, China, between January 1, 1993 and December 31, 2014. CARPREG and ZAHARA risk scores, and modified WHO (mWHO) risk classification were applied retrospectively. Predictive accuracy was compared by receiver operating characteristic curve analysis.
  
  
  RESULTS
  A total of 730 women were included. The frequency of expected versus observed cardiac events was, respectively, 5.0% versus 7.8%, 27.0% versus 47.1%, and 75.0% versus 75.0% among patients with CARPREG scores of 0, 1, and >1; and 2.9% versus 5.8%, 7.5% versus 36.5%, 17.5% versus 30.8%, 43.1% versus 50.0%, and 70.0% versus 17.6% among those with ZAHARA scores of 0-0.50, 0.51-1.50, 1.51-2.50, 2.51-3.50, and 3.51 or more. For mWHO risk classifications I-IV, the cardiac event rate was 0%, 8.2%, 26.7%, 18.4%, and 15.4%, respectively. The area under the curve was 0.71 (95% confidence interval [CI] 0.67-0.76; P<0.001) for mWHO, 0.68 (95% CI 0.60-0.75; P<0.001) for ZAHARA, and 0.63 (95% CI 0.57-0.71; P=0.001) for CARPREG.
  
  
  CONCLUSIONS
  The mWHO risk classification was the best system for predicting cardiac complications among Chinese pregnant women with CHD.
authors.affiliation: Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Shanghai Obstetrical Cardiology Intensive Care Center, Shanghai, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Fu
authors.affiliation: Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Shanghai Obstetrical Cardiology Intensive Care Center, Shanghai, China. Electronic address: linjhuarj@126.com.
authors.forename: Jianhua
authors.initials: J
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications*; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000145:classification* / Q000209:etiology / Q000628:therapy*; D011277:Pregnanediones; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D019616:Thoracic Surgical Procedures / Q000706:statistics & numerical data; D014944:World Health Organization; D055815:Young Adult
chemical_list: D011277:Pregnanediones; C084598:hydroxydione
keywords: Cardiac complications; Congenital heart disease; Pregnancy; Risk score