A risk score combining LDL >110 mg/dl (HR 8.7), triglycerides >140 mg/dl (HR 7.8), >2 rejections (HR 3.3), CMV infection (HR 3.6), and CAD better predicts MACE (94.9% vs 64.7%, p<0.01) in heart transp
Does SCORE2 risk stratification predict major cardiovascular events in heart transplanted patients?
Traditional cardiovascular risk scores like SCORE2 do not accurately predict MACE in heart transplant recipients, whereas a score incorporating metabolic and immunological factors provides better risk stratification.
Absolute Event Rate: 0% vs 0%
Abstract Introduction The risk factors used to predict cardiovascular (CV) risk in heart transplanted (HT) patients are usually considered the same of the general population; however, the validity of this approach has never been investigated. Moreover, despite the recommended use of statins to all patients, a target of LDL cholesterol is not defined. Purpose The aim of our study is to verify if the traditional risk factors cited by current European Society of Cardiology (ESC) guidelines can be used to predict the risk of major cardiovascular events (MACE) in HT patients. Methods In our single center study of prospectively collected data (EC code: PNC0000002), we included all adult patients heart transplanted in our Center (2013-23) surviving at least one year after HT. We collected data about CV and immunological risk factors (rejection, CMV infection) at one month and one year after HT. Patients were stratified into low, intermediate and high/very high risk according to SCORE2 ,as recommended by current European Society of Cardiology (ESC) guidelines. The endpoint was freedom from MACE (excluding cellular rejection) 10 years after transplant. Results Among 189 patients (73% males, 52±12 yrs), 30% had ischemic etiology (CAD), 22% diabetes, 70 % hypertension; donor age was 46±14 yrs. Despite an increasing use of statins during the first year (46.4% vs 77.9%, one month vs one year, p0.01) leading to a decrease in LDL, still 55% of pts had LDL100 mg/dl at 1yr. The use of SCORE2 as by ESC guidelines did not predict 10-yrs prognosis (80.4±14.9% vs 77.3±6.5% vs 85.2±7.2% vs 7.2±9.2% low vs intermediate vs high vs very high, p=0.6). At univariate analysis, we identified the following 1-yr variables: 1-yr LDL, (110 mg/dl, HR:8.7), triglycerides 140 mg/dl, HR:7.8 (both by ROC analysis), 2 episodes of cellular rejection (2R) in the first year (HR:3.3), treated CMV infection (HR: 3.6), p0.01 all, CAD with a borderline statistical significance (HR:2.8, p=0.08); of note, antiplatelets, mTOR inhibitors, donor-specific antibodies (DSAs) and steroids did not predict MACE. By scoring each of the above risk factors according to its HR (2 points for TG and LDL, 1 for the others), we created two risk groups (0- 3 vs ³4 points), that were able to stratify MACE (94.9±2.8% vs 64.7±9.3%, p0.01), even after adjusting for donor age 45 yrs (median). Conclusions In heart transplanted patients, traditional tools (e.g. SCORE2) seem not able to stratify CV risk. A score including metabolic (LDL cholesterol, triglycerides) and immunological risk factors (rejection history, CMV infection) and ischemic etiology seems to better stratify CV events regardless of donor age. These results reflect the multifactorial etiology of CAV.
Masetti et al. (Sat,) reported a other. A risk score combining LDL >110 mg/dl (HR 8.7), triglycerides >140 mg/dl (HR 7.8), >2 rejections (HR 3.3), CMV infection (HR 3.6), and CAD better predicts MACE (94.9% vs 64.7%, p<0.01) in heart transp.