title: Comparative Evaluation of Four Risk Scores for Predicting Mortality in Patients With Implantable Cardioverter-defibrillator for Primary Prevention.
abstract: OBJECTIVE
  Several clinical risk scores have been developed to identify patients at high risk of all-cause mortality despite implantation of an implantable cardioverter-defibrillator. We aimed to examine and compare the predictive capacity of 4 simple scoring systems (MADIT-II, FADES, PACE and SHOCKED) for predicting mortality after defibrillator implantation for primary prevention of sudden cardiac death in a Mediterranean country.
  
  
  METHODS
  A multicenter retrospective study was performed in 15 Spanish hospitals. Consecutive patients referred for defibrillator implantation between January 2010 and December 2011 were included.
  
  
  RESULTS
  A total of 916 patients with ischemic and nonischemic heart disease were included (mean age, 62 ± 11 years, 81.4% male). Over 33.4 ± 12.9 months, 113 (12.3%) patients died (cardiovascular origin in 86 [9.4%] patients). At 12, 24, 36, and 48 months, mortality rates were 4.5%, 7.6%, 10.8%, and 12.3% respectively. All the risk scores showed a stepwise increase in the risk of death throughout the scoring system of each of the scores and all 4 scores identified patients at greater risk of mortality. The scores were significantly associated with all-cause mortality throughout the follow-up period. PACE displayed the lowest c-index value regardless of whether the population had heart disease of ischemic (c-statistic = 0.61) or nonischemic origin (c-statistic = 0.61), whereas MADIT-II (c-statistic = 0.67 and 0.65 in ischemic and nonischemic cardiomyopathy, respectively), SHOCKED (c-statistic = 0.68 and 0.66, respectively), and FADES (c-statistic = 0.66 and 0.60) provided similar c-statistic values (P ≥ .09).
  
  
  CONCLUSIONS
  In this nontrial-based cohort of Mediterranean patients, the 4 evaluated risk scores showed a significant stepwise increase in the risk of death. Among the currently available risk scores, MADIT-II, FADES, and SHOCKED provide slightly better performance than PACE.
authors: Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
authors: Moisés
authors: M
authors: Rodríguez-Mañero
authors: Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
authors: Emad
authors: E
authors: Abu Assi
authors: Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain.
authors: Juan Miguel
authors: JM
authors: Sánchez-Gómez
authors: Unidad de Arritmias, Servicio de Cardiología, Hospital Puerta del Mar, Cádiz, Spain.
authors: Juan
authors: J
authors: Fernández-Armenta
authors: Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen Macarena, Seville, Spain.
authors: Ernesto
authors: E
authors: Díaz-Infante
authors: Unidad de Arritmias, Servicio de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
authors: Ignacio
authors: I
authors: García-Bolao
authors: Unidad de Arritmias, Servicio de Cardiología, Hospital Fundación Jiménez Díaz, Madrid, Spain.
authors: Juan
authors: J
authors: Benezet-Mazuecos
authors: Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario La Fe, Valencia, Spain.
authors: Ana
authors: A
authors: Andrés Lahuerta
authors: Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain.
authors: Víctor
authors: V
authors: Expósito-García
authors: Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario San Juan, Sant Joan d'Alacant, Alicante, Spain.
authors: Vicente
authors: V
authors: Bertomeu-González
authors: Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Seville, Spain.
authors: Álvaro
authors: Á
authors: Arce-León
authors: Unidad de Arritmias, Servicio de Cardiología, Hospital Virgen de las Nieves, Granada, Spain.
authors: María Teresa
authors: MT
authors: Barrio-López
authors: Sección de Electrofisiología y Arritmias, Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
authors: Rafael
authors: R
authors: Peinado
authors: Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
authors: Luis
authors: L
authors: Martínez-Sande
authors: Unidad de Arritmias y Electrofisiología Cardiaca, Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, Spain. Electronic address: maapalomares@secardiologia.es.
authors: Miguel A
authors: MA
authors: Arias
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology; D002423:Cause of Death; D003404:Creatinine / Q000097:blood; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D003920:Diabetes Mellitus / Q000453:epidemiology; D004554:Electric Countershock; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011322:Primary Prevention; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012907:Smoking / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology; D013318:Stroke Volume
chemical_list: D003404:Creatinine
keywords: Desfibrilador automático implantable; Implantable cardioverter-defibrillator; Muerte súbita cardiaca; Prevención primaria; Primary prevention; Puntuaciones de riesgo; Risk scores; Sudden cardiac death