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Risk stratification in chronic thromboembolic pulmonary hypertension predicts survival.

Artikel i vetenskaplig tidskrift
Författare Anna Sandqvist
David Kylhammar
Sven-Erik Bartfay
Roger Hesselstrand
Clara Hjalmarsson
Mohammad Kavianipour
Magnus Nisell
Göran Rådegran
Gerhard Wikström
Barbro Kjellström
Stefan Söderberg
Publicerad i Scandinavian cardiovascular journal : SCJ
Sidor 1-7
ISSN 1651-2006
Publiceringsår 2020
Publicerad vid Institutionen för medicin
Institutionen för medicin, avdelningen för molekylär och klinisk medicin
Sidor 1-7
Språk en
Länkar dx.doi.org/10.1080/14017431.2020.17...
www.ncbi.nlm.nih.gov/entrez/query.f...
Ämneskategorier Kardiovaskulär medicin

Sammanfattning

Objectives. To investigate if the pulmonary arterial hypertension (PAH) risk assessment tool presented in the 2015 ESC/ERS guidelines is valid for patients with chronic thromboembolic pulmonary hypertension (CTEPH) when taking pulmonary endarterectomy (PEA) into account. Design. Incident CTEPH patients registered in the Swedish PAH Registry (SPAHR) between 2008 and 2016 were included. Risk stratification performed at baseline and follow-up classified the patients as low-, intermediate-, or high-risk using the proposed ESC/ERS risk algorithm. Results. There were 250 CTEPH patients with median age (interquartile range) 70 (14) years, and 53% were male. Thirty-two percent underwent PEA within 5 (6) months. In a multivariable model adjusting for age, sex, and pharmacological treatment, patients with intermediate-risk or high-risk profiles at baseline displayed an increased mortality risk (Hazard Ratio [95% confidence interval]: 1.64 [0.69-3.90] and 5.39 [2.13-13.59], respectively) compared to those with a low-risk profile, whereas PEA was associated with better survival (0.38 [0.18-0.82]). Similar impact of risk profile and PEA was seen at follow-up. Conclusion. The ESC/ERS risk assessment tool identifies CTEPH patients with reduced survival. Furthermore, PEA improves survival markedly independently of risk group and age. Take home message: The ESC/ERS risk stratification for PAH predicts survival also in CTEPH patients, even when taking PEA into account.

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