@Article{chd.12750,
AUTHOR = {Yuli Y. Kim, Leah A. Goldberg, Katherine Awh, Tanmay Bhamare, David Drajpuch, Adi Hirshberg, Sara L. Partington, Rachel Rogers, Emily Ruckdeschel, Lynda Tobin, Morgan Venuti, Lisa D. Levine},
TITLE = {Accuracy of risk prediction scores in pregnant women with congenital heart disease},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {14},
YEAR = {2019},
NUMBER = {3},
PAGES = {470--478},
URL = {http://www.techscience.com/schd/v14n3/38795},
ISSN = {3071-1738},
ABSTRACT = {<b>Objective:</b> 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.<br/>
<b>Design:</b> Single‐center retrospective study.<br/>
<b>Setting:</b> Tertiary care academic hospital.<br/>
<b>Patients:</b> 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.<br/>
<b>Outcome Measures:</b> 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.<br/>
<b>Results:</b> 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).<br/>
<b>Conclusions:</b> 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.},
DOI = {10.1111/chd.12750}
}