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Accuracy of risk prediction scores in pregnant women with congenital heart disease

Yuli Y. Kim1,2, Leah A. Goldberg2, Katherine Awh2, Tanmay Bhamare1,2, David Drajpuch2, Adi Hirshberg3, Sara L. Partington1,2, Rachel Rogers4, Emily Ruckdeschel1,2, Lynda Tobin1, Morgan Venuti2, Lisa D. Levine3

1 Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
2 Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
3 Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine Philadelphia, Pennsylvania
4 Biostatistics and Data Management Core, The Children’s Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania

* Corresponding Author: Yuli Y. Kim MD, Philadelphia Adult Congenital Heart Center Penn Medicine & The Children’s Hospital of Philadelphia, 3400 Civic Center Boulevard, PCAM 2nd Floor E. Pavilion Philadelphia, PA 19104. Email: email

Congenital Heart Disease 2019, 14(3), 470-478. https://doi.org/10.1111/chd.12750

Abstract

Objective: To assess performance of risk stratification schemes in predicting adverse cardiac outcomes in pregnant women with congenital heart disease (CHD) and to compare these schemes to clinical factors alone.
Design: Single‐center retrospective study.
Setting: Tertiary care academic hospital.
Patients: Women ≥18 years with International Classification of Diseases, Ninth Revision, Clinical Modification codes indicating CHD who delivered between 1998 and 2014. CARPREG I and ZAHARA risk scores and modified World Health Organization (WHO) criteria were applied to each woman.
Outcome Measures: The primary outcome was defined by ≥1 of the following: arrhyth‐ mia, heart failure/pulmonary edema, transient ischemic attack, stroke, dissection, myo‐ cardial infarction, cardiac arrest, death during gestation and up to 6 months postpartum.
Results: Of 178 women, the most common CHD lesions were congenital aortic ste‐ nosis (15.2%), ventricular septal defect (13.5%), atrial septal defect (12.9%), and te‐ tralogy of Fallot (12.9%). Thirty‐five women (19.7%) sustained 39 cardiac events. Observed vs expected event rates were 9.9% vs 5% (P = .02) for CARPREG I score 0 and 26.1% vs 7.5% (P < .001) for ZAHARA scores 0.51‐1.5. ZAHARA outperformed CARPREG I at predicting adverse cardiovascular outcomes (AUC 0.80 vs 0.72, P = .03) but was not significantly better than modified WHO. Clinical predictors of adverse cardiac event were symptoms (P = .002), systemic ventricular dysfunction (P < .001), and subpulmonary ventricular dysfunction (P = .03) with an AUC 0.83 comparable to ZAHARA (P = .66).
Conclusions: CARPREG I and ZAHARA scores underestimate cardiac risk for lower risk pregnancies in these women. Of the three risk schemes, CARPREG I performed least well in predictive capacity. Clinical factors specific to the population studied are comparable to stratification schemes.

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Cite This Article

APA Style
Kim, Y.Y., Goldberg, L.A., Awh, K., Bhamare, T., Drajpuch, D. et al. (2019). Accuracy of risk prediction scores in pregnant women with congenital heart disease. Congenital Heart Disease, 14(3), 470-478. https://doi.org/10.1111/chd.12750
Vancouver Style
Kim YY, Goldberg LA, Awh K, Bhamare T, Drajpuch D, Hirshberg A, et al. Accuracy of risk prediction scores in pregnant women with congenital heart disease. Congeni Heart Dis. 2019;14(3):470-478 https://doi.org/10.1111/chd.12750
IEEE Style
Y.Y. Kim et al., "Accuracy of risk prediction scores in pregnant women with congenital heart disease," Congeni. Heart Dis., vol. 14, no. 3, pp. 470-478. 2019. https://doi.org/10.1111/chd.12750



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