Abstract
Rationale Current pulmonary hypertension treatment guidelines recommend use of a risk stratification model encompassing a range of parameters, allowing patients to be categorised as low, intermediate, or high risk. Three abbreviated versions of this risk stratification model were previously evaluated in patients with pulmonary arterial hypertension in the French, Swedish, and COMPERA registries.
Objective To investigate 3 abbreviated risk stratification methods for patients with mostly prevalent pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension, in patients from the PATENT-1/-2 and CHEST-1/-2 studies of riociguat.
Methods Risk was assessed at baseline and at follow-up in PATENT-1 and CHEST-1. Survival and clinical worsening-free survival were assessed in patients in each risk group/strata.
Measurements and Main Results With all 3 methods, riociguat improved risk group/strata in patients with pulmonary arterial hypertension after 12 weeks. The French non-invasive and Swedish/COMPERA methods discriminated prognosis for survival and clinical worsening-free survival at both baseline and follow-up. Furthermore, patients achieving ≥1 low-risk criteria or a low-risk stratum at follow-up had a significantly reduced risk of death and clinical worsening, compared with patients achieving no low-risk criteria or an intermediate-risk stratum. Similar results were obtained in patients with inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension.
Conclusions This analysis confirms and extends the results of the registry analyses, supporting the value of goal-oriented treatment in pulmonary arterial hypertension. Further assessment of these methods in patients with chronic thromboembolic pulmonary hypertension is warranted.
Footnotes
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Conflict of interest: Dr. FARBER reports grants from Actelion, Gilead, United Therapeutics, personal fees from Actelion, Bayer, Bellerophon, Gilead, United Therapeutics, during the conduct of the study.
Conflict of interest: Dr. GHOFRANI reports grants and personal fees from Actelion, grants and personal fees from Bayer AG, grants and personal fees from Ergonex, grants and personal fees from Pfizer, personal fees from Gilead, personal fees from GSK, personal fees from Merck, personal fees from Novartis, outside the submitted work.
Conflict of interest: Dr. BENZA reports grants from Belleraphon, grants from Bayer AG, grants from Actelion, grants from EIGER, during the conduct of the study; .Dr. BENZA reports grants from Belleraphon, grants from Bayer AG, grants from Actelion, grants from EIGER, during the conduct of the study.
Conflict of interest: Dr. BUSSE reports other from Bayer AG, during the conduct of the study.
Conflict of interest: Dr. MEIER reports other from Bayer AG, during the conduct of the study.
Conflict of interest: Dr. HOEPER reports consultancy fees from Actelion, Bayer AG, GSK, and Pfizer, during the conduct of the study.
Conflict of interest: Dr. HUMBERT reports personal fees from Bayer, personal fees from Merck, during the conduct of the study; personal fees from Actelion, and support from GSK, from Johnson & Johnson, from United Therapeutics, outside the submitted work.
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