• Olivier Sitbon, Kelly M Chin, Richard N Channick, Raymond L Benza, Lilla Di Scala, Sean Gaine, Hossein-Ardeschir Ghofrani, Irene M Lang, Vallerie V McLaughlin, Ralph Preiss, Lewis J Rubin, Gérald Simonneau, Victor F Tapson, Nazzareno Galiè, and Marius M Hoeper.
• Hôpital Universitaire de Bicêtre, Université Paris Sud, Le Kremlin-Bicêtre, France. Electronic address: olivier.sitbon@u-psud.fr.
• J. Heart Lung Transplant. 2020 Apr 1; 39 (4): 300-309.

BackgroundApproaches to risk assessment in pulmonary arterial hypertension (PAH) include the noninvasive French risk assessment approach (number of low-risk criteria based on the European Society of Cardiology and European Respiratory Society guidelines) and Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL) 2.0 risk calculator. The prognostic and predictive value of these methods for morbidity/mortality was evaluated in the predominantly prevalent population of GRIPHON, the largest randomized controlled trial in PAH.MethodsGRIPHON randomized 1,156 patients with PAH to selexipag or placebo. Post-hoc analyses were performed on the primary composite end-point of morbidity/mortality by the number of low-risk criteria (World Health Organization functional class I-II; 6-minute walk distance >440 m; N-terminal pro-brain natriuretic peptide <300 ng/liter) and REVEAL 2.0 risk category. Hazard ratios and 95% confidence intervals were calculated using Cox proportional hazard models.ResultsBoth the number of low-risk criteria and the REVEAL 2.0 risk category were prognostic for morbidity/mortality at baseline and any time-point during the study. Patients with 3 low-risk criteria at baseline had a 94% reduced risk of morbidity/mortality compared to patients with 0 low-risk criteria and were all categorized as low-risk by REVEAL 2.0. The treatment effect of selexipag on morbidity/mortality was consistent irrespective of the number of low-risk criteria or the REVEAL 2.0 risk category at any time-point during the study. Selexipag-treated patients were more likely to increase their number of low-risk criteria from baseline to week 26 than placebo-treated patients (odds ratio 1.69, p = 0.0002); similar results were observed for REVEAL 2.0 risk score.ConclusionsThese results support the association between risk profile and long-term outcome and suggest that selexipag treatment may improve risk profile.Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

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