TY - EJOU
AU - Kim, Yuli Y.
AU - Goldberg, Leah A.
AU - Awh, Katherine
AU - Bhamare, Tanmay
AU - Drajpuch, David
AU - Hirshberg, Adi
AU - Partington, Sara L.
AU - Rogers, Rachel
AU - Ruckdeschel, Emily
AU - Tobin, Lynda
AU - Venuti, Morgan
AU - Levine, Lisa D.
TI - Accuracy of risk prediction scores in pregnant women with congenital heart disease
T2 - Congenital Heart Disease
PY - 2019
VL - 14
IS - 3
SN - 1747-0803
AB - 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.
KW - adult congenital heart disease
KW - outcomes
KW - pregnancy
KW - risk stratification
DO - 10.1111/chd.12750