ALERT-CS - Development of an ECG-based cardiac syncope ... .pdf · §15 recruitment centers in 9...
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Tobias Zimmermann, MD ESC Congress, Paris (FR) Sept 1 st , 2019 ALERT-CS – Development and validation of an ECG-based cardiac syncope risk calculator
Transcript of ALERT-CS - Development of an ECG-based cardiac syncope ... .pdf · §15 recruitment centers in 9...
Tobias Zimmermann, MDESC Congress, Paris (FR)Sept 1st, 2019
ALERT-CS – Development and validation of an ECG-based cardiac syncope risk calculator
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Disclosures
Introduction
1-2% of all ED visits50% discharged w/ unknown syncope
Introduction
1-2% of all ED visits50% discharged w/ unknown syncope
15% cardiac syncope
30% mortality per year
§ Aim: To improve the early diagnosis of cardiac syncope and enhance the management of patients with syncope on the Emergency Department.
§ Definition of cardiac syncope: Tachy- / bradyarrhythmia, severe structural heart disease, congenital anomaly, aortic dissection or pulmonary hypertension leading to a transient loss of consciousness.
§ Prospective international diagnostic multicenter study§ 15 recruitment centers in 9 countries on 4 continents§ > 3000 patients recruited
BAsel Syncope EvaLuation (BASEL IX) study
BAsel Syncope EvaLuation (BASEL IX) study
Standardized recordings
12-lead ECGLarge biobank
Long-term follow-upDiagnostic adjudication
BAsel Syncope EvaLuation (BASEL IX) study
Standardized recordings
12-lead ECGLarge biobank
Long-term follow-upDiagnostic adjudication
Penalized stepwise backward selection
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QRS axis
Bundle branch block
ST-depression
ST-elevation
Q-wave T-wave inversion
Rhythm
QTc-interval
Heart rate
AV-block
LVH
Ventricular ES/nsVT
QRS interval
Bundle branch block
ST-depression
Rhythm
AV-block
Ventricular ES/nsVT
QTc-intervalHeart rate
categorical continuous
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§ Good diagnostic discrimination (AUC 0.80, 95%-CI 0.77 to 0.83)
§ Good internal calibration(bootstrapped, 1000x)
Diagnostic performance
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Prognostic performance
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§ Prognostic performance at 30d:
§ Slightly worse for overall and arrhythmic MACE(AUC 0.70, 95%-CI 0.65 - 0.74, AUC 0.72, 95%-CI 0.67 - 0.78)
§ Very similar for death(AUC 0.64, 95%-CI 0.53 - 0.75)
Prognostic external validation – SRS study (USA)
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§ Only patients in the ED, unclear if applicable to patients in primary care
§ ECG interpretation, inter-interpreter variability
§ Diagnostic adjudication, not 100% perfect
Limitations
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ALERT-CS - Conclusion
§ Fast, cheap, easy-to-use tool to identify patients at high risk for cardiac syncope (No rule-out tool!)
§ Complements other currently available tools like biomarkers and medical history
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