Details

Autor(en) / Beteiligte

• Hoeper, Marius M.
• Pausch, Christine
• Olsson, Karen M.
• Huscher, Doerte
• Pittrow, David
• Grünig, Ekkehard
• Staehler, Gerd
• Vizza, Carmine Dario
• Gall, Henning
• Distler, Oliver
• Opitz, Christian
• Gibbs, J. Simon R.
• Delcroix, Marion
• Ghofrani, H. Ardeschir
• Park, Da-Hee
• Ewert, Ralf
• Kaemmerer, Harald
• Kabitz, Hans-Joachim
• Skowasch, Dirk
• Behr, Juergen
• Milger, Katrin
• Halank, Michael
• Wilkens, Heinrike
• Seyfarth, Hans-Jürgen
• Held, Matthias
• Dumitrescu, Daniel
• Tsangaris, Iraklis
• Vonk-Noordegraaf, Anton
• Ulrich, Silvia
• Klose, Hans
• Claussen, Martin
• Lange, Tobias J.
• Rosenkranz, Stephan

Titel

COMPERA 2.0: a refined four-stratum risk assessment model for pulmonary arterial hypertension

Ist Teil von

• The European respiratory journal, 2022-07, Vol.60 (1), p.2102311

Ort / Verlag

European Respiratory Society

Erscheinungsjahr

2022

Link zum Volltext

Quelle

EZB-FREE-00999 freely available EZB journals

Beschreibungen/Notizen

• Background Risk stratification plays an essential role in the management of patients with pulmonary arterial hypertension (PAH). The current European guidelines propose a three-stratum model to categorise risk as low, intermediate or high, based on the expected 1-year mortality. However, with this model, most patients are categorised as intermediate risk. We investigated a modified approach based on four risk categories, with intermediate risk subdivided into intermediate-low and intermediate-high risk. Methods We analysed data from the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA), a European pulmonary hypertension registry, and calculated risk at diagnosis and first follow-up based on World Health Organization functional class, 6-min walk distance (6MWD) and serum levels of brain natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP), using refined cut-off values. Survival was assessed using Kaplan–Meier analyses, log-rank testing and Cox proportional hazards models. Results Data from 1655 patients with PAH were analysed. Using the three-stratum model, most patients were classified as intermediate risk (76.0% at baseline and 63.9% at first follow-up). The refined four-stratum risk model yielded a more nuanced separation and predicted long-term survival, especially at follow-up assessment. Changes in risk from baseline to follow-up were observed in 31.1% of the patients with the three-stratum model and in 49.2% with the four-stratum model. These changes, including those between the intermediate-low and intermediate-high strata, were associated with changes in long-term mortality risk. Conclusions Modified risk stratification using a four-stratum model based on refined cut-off levels for functional class, 6MWD and BNP/NT-proBNP was more sensitive to prognostically relevant changes in risk than the original three-stratum model.