Predicting Survival in Patients Receiving Continuous Flow Left Ventricular Assist Devices The HeartMate II Risk Score
Predicting Survival in Patients Receiving Continuous Flow Left Ventricular Assist Devices The HeartMate II Risk Score
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DOI：
10.1016/j.jacc.2012.09.055
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发表时间：
2013-01-22
影响因子：
24
通讯作者：
Slaughter, Mark S.
中科院分区：
文献类型：
--
作者：
Cowger, Jennifer;Sundareswaran, Kartik;Slaughter, Mark S.
目的本研究的目的是推导和验证一个模型来预测HeartMate II（HMII）（Thoratec，普莱森顿，加州）左心室辅助装置（LVAD）支持的候选人的生存率。随着LVAD支持的发展，先前的风险预测模型已变得不那么valid.Methods患者入组的HMII桥移植和目的地治疗试验（N = 1，122）被随机分为衍生（DC）（n = 583）和验证队列（VC）（n = 539）。在DC中使用逻辑回归检查了90天死亡率的术前候选预测因素，从中得出HMII风险评分（HMRS）。结果90 d内死亡149例（13%）。在DC中，老年患者的死亡率（n = 80）较高（比值比[OR]：1.3，95%置信区间[CI]：1.1 - 1.7/10年），低白蛋白血症严重者（OR：0.49，95% CI：0.31 - 0.76/mg/dl白蛋白），肾功能不全（OR：2.1，95% CI：1.4 - 3.2/mg/dl肌酐），凝血功能障碍（OR：3.1，95% CI：1.7 - 5.8/国际标准化比率单位），在经验不足的中心接受LVAD支持的患者中（OR：2.2，95% CI：1.2至4.4，
Objectives The aim of this study was to derive and validate a model to predict survival in candidates for HeartMate II (HMII) (Thoratec, Pleasanton, California) left ventricular assist device (LVAD) support.Background LVAD mortality risk prediction is important for candidate selection and communicating expectations to patients and clinicians. With the evolution of LVAD support, prior risk prediction models have become less valid.Methods Patients enrolled into the HMII bridge to transplantation and destination therapy trials (N = 1,122) were randomly divided into derivation (DC) (n = 583) and validation cohorts (VC) (n = 539). Pre-operative candidate predictors of 90-day mortality were examined in the DC with logistic regression, from which the HMII Risk Score (HMRS) was derived. The HMRS was then applied to the VC.Results There were 149 (13%) deaths within 90 days. In the DC, mortality (n = 80) was higher in older patients (odds ratio [OR]: 1.3, 95% confidence interval [CI]: 1.1 to 1.7 per 10 years), those with greater hypoalbuminemia (OR: 0.49, 95% CI: 0.31 to 0.76 per mg/dl of albumin), renal dysfunction (OR: 2.1, 95% CI: 1.4 to 3.2 per mg/dl creatinine), coagulopathy (OR: 3.1, 95% CI: 1.7 to 5.8 per international normalized ratio unit), and in those receiving LVAD support at less experienced centers (OR: 2.2, 95% CI: 1.2 to 4.4 for