Usefulness of the INTERMACS Scale to Predict Outcomes After Mechanical Assist Device Implantation

Alba, Ana C.; Rao, Vivek; Ivanov, Joan; Ross, Heather J.; Delgado, Diego

doi:10.1016/j.healun.2009.04.033

Cited by 143 publications

(111 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This finding is in line with published data from the INTER-MACS database. 27 We categorized patients according to ORIGINAL RESEARCH ARTICLE the modifiers of the INTERMACS profile definition into a group of hospitalized patients on intravenous inotropes or temporary circulatory support (class 1 through 3) and a second group including "frequent flyers" (class 4) and less sick (class 5 through 7) patients. 28 The first group represents sicker and decompensating patients who suffer severe hemodynamic derangement, threatening secondary organ (renal, hepatic) failure, compared with ambulatory, less sick, or relatively stable patients in the second group.…”

Section: Downloaded Frommentioning

confidence: 99%

Derivation and Validation of a Novel Right-Sided Heart Failure Model After Implantation of Continuous Flow Left Ventricular Assist Devices

Soliman¹,

Akın

Muslem³

et al. 2018

Circulation

199

View full text Add to dashboard Cite

ARTICLE ORIGINAL RESEARCH ARTICLEEditorial, see p XXX BACKGROUND: The aim of the study was to derive and validate a novel risk score for early right-sided heart failure (RHF) after left ventricular assist device implantation. METHODS:The European Registry for Patients with Mechanical Circulatory Support (EUROMACS) was used to identify adult patients undergoing continuous-flow left ventricular assist device implantation with mainstream devices. Eligible patients (n=2988) were randomly divided into derivation (n=2000) and validation (n=988) cohorts. The primary outcome was early (<30 days) severe postoperative RHF, defined as receiving short-or long-term rightsided circulatory support, continuous inotropic support for ≥14 days, or nitric oxide ventilation for ≥48 hours. The secondary outcome was all-cause mortality and length of stay in the intensive care unit. Covariates found to be associated with RHF (exploratory univariate P<0.10) were entered into a multivariable logistic regression model. A risk score was then generated using the relative magnitude of the exponential regression model coefficients of independent predictors at the last step after checking for collinearity, likelihood ratio test, c index, and clinical weight at each step.RESULTS: A 9.5-point risk score incorporating 5 variables (Interagency Registry for Mechanically Assisted Circulatory Support class, use of multiple inotropes, severe right ventricular dysfunction on echocardiography, ratio of right atrial/ pulmonary capillary wedge pressure, hemoglobin) was created. The mean scores in the derivation and validation cohorts were 2.7±1.9 and 2.6±2.0, respectively (P=0.32). RHF in the derivation cohort occurred in 433 patients (21.7%) after left ventricular assist device implantation and was associated with a lower 1-year (53% versus 71%; P<0.001) and 2-year (45% versus 58%; P<0.001) survival compared with patients without RHF. RHF risk ranged from 11% (low risk score 0-2) to 43.1% (high risk score >4; P<0.0001). Median intensive care unit stay was 7 days (interquartile range, 4-15 days) versus 24 days (interquartile range, 14-38 days) in patients without versus with RHF, respectively (P<0.001). The c index of the composite score was 0.70 in the derivation and 0.67 in the validation cohort. The EUROMACS-RHF risk score outperformed (P<0.0001) previously published scores and known individual echocardiographic and hemodynamic markers of RHF. CONCLUSIONS:This novel EUROMACS-RHF risk score outperformed currently known risk scores and clinical predictors of early postoperative RHF. This novel score may be useful for tailored risk-based clinical assessment and management of patients with advanced HF evaluated for ventricular assist device therapy. 1,2 Early post-LVAD mortality is due partly to the development of right-sided HF (RHF) in the early post-LVAD phase. 3 The pathophysiology of RHF, however, is not well known.4,5 Post-LVAD RHF has been reported to be between 4% and 50%, 6-10 and RHF-associated 6-month mortality was seen in up to 29% of patients ...

show abstract

Section: Downloaded Frommentioning

confidence: 99%

Derivation and Validation of a Novel Right-Sided Heart Failure Model After Implantation of Continuous Flow Left Ventricular Assist Devices

Soliman¹,

Akın

Muslem³

et al. 2018

Circulation

199

View full text Add to dashboard Cite

show abstract

“…Device support ranges from several days to weeks. 13 Although the operative risk of device implantation in these very ill patients is higher than in more stable HF patients, 14,15 these patients make up the vast majority of MCS implant recipients. Lietz et al 16 developed a scoring system to grade the futility of left ventricular assist device (LVAD) surgery in 222 patients who underwent placement of a destination LVAD.…”

Section: Cardiogenic Shock and Patients Declining On Inotropes (Intermentioning

confidence: 99%

“…Although new clinical algorithms have been proposed to guide the earlier timing of MCS in high-urgency HT candidates, 14 there are no standardized guidelines for elective device placement. With recent reports suggesting that MCS placement may be associated with decreased survival after cardiac transplantation, early device placement continues to generate much debate, and there is considerable variation in the threshold for MCS placement among transplant centers.…”

Section: Cardiogenic Shock and Patients Declining On Inotropes (Intermentioning

confidence: 99%

Selection of Cardiac Transplantation Candidates in 2010

2010

View full text Add to dashboard Cite

“…These significant pre-implant variables were selected based on prior studies. [16][17][18] All tests were 2 sided, and P values <0.05 were considered statistically significant. All analyses were performed using SAS version 8.2 (SAS Institute, Cary, NC).…”

Section: Discussionmentioning

confidence: 99%

Regional Differences in Utilization and Outcomes of Left Ventricular Assist Devices: Insights from the INTERMACS Registry

Krim

Vivo

Campbell

et al. 2014

The Journal of Heart and Lung Transplantation

View full text Add to dashboard Cite

Usefulness of the INTERMACS Scale to Predict Outcomes After Mechanical Assist Device Implantation

Cited by 143 publications

References 19 publications

Derivation and Validation of a Novel Right-Sided Heart Failure Model After Implantation of Continuous Flow Left Ventricular Assist Devices

Derivation and Validation of a Novel Right-Sided Heart Failure Model After Implantation of Continuous Flow Left Ventricular Assist Devices

Selection of Cardiac Transplantation Candidates in 2010

Regional Differences in Utilization and Outcomes of Left Ventricular Assist Devices: Insights from the INTERMACS Registry

Contact Info

Product

Resources

About