Usefulness of the INTERMACS Scale for Predicting Outcomes After Urgent Heart Transplantation

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• 作者：Eduardo Barge-Caballero^a ; ^{blargesbueno@hotmail.com} ; Mar&#xed ; a J. Paniagua-Mart&#xed ; n^a ; Raquel Marzoa-Rivas^a ; Rosa Campo-P&#xe9 ; rez^a ; Jos&#xe9 ; Á ; ngel Rodr&#xed ; guez-Fern&#xe1 ; ndez^a ; Alberto P&#xe9 ; rez-P&#xe9 ; rez^a ; Lourdes Garc&#xed ; a-Bueno^a ; Paula Blanco-Canosa^a ; Zulaika Grille Cancela^a ; Miguel Solla-Buceta^a ; Alberto Juff&#xe9 ; -Stein^a ; Jos&#xe9 ; M. Herrera-Noreñ ; a^a ; Jos&#xe9 ; J. Cuenca-Castillo^a ; Javier Muñ ; iz^b ; Alfonso Castro-Beiras^a ; ^b ; Mar&#xed ; a G. Crespo-Leiro^a
• 关键词：INTERMACS ; Heart transplantation ; Heart failure ; Prognosis
• 刊名：Revista Española de Cardiología (English Edition)
• 出版年：2011
• 出版时间：March 2011
• 年：2011
• 卷：64
• 期：3
• 页码：193-200
• 全文大小：238 K

文摘

Introduction and objectives

Our aim was to assess the prognostic value of the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) scale in patients undergoing urgent heart transplantation (HT).

Methods

Retrospective analysis of 111 patients treated with urgent HT at our institution from April, 1991 to October, 2009. Patients were retrospectively assigned to three levels of the INTERMACS scale according to their clinical status before HT.

Results

Patients at the INTERMACS 1 level (n = 31) more frequently had ischemic heart disease (p = 0.03) and post-cardiothomy shock (p = 0.02) than patients at the INTERMACS 2 (n = 55) and INTERMACS 3-4 (n = 25) levels. Patients at the INTERMACS 1 level showed higher preoperative catecolamin doses (p = 0.001), a higher frequency of use of mechanical ventilation (p < 0.001), intraaortic balloon (p = 0.002) and ventricular assist devices (p = 0.002), and a higher frequency of preoperative infection (p = 0.015). The INTERMACS 1 group also presented higher central venous pressure (p = 0.02), AST (p = 0.002), ALT (p = 0.006) and serum creatinine (p < 0.001), and lower hemoglobin (p = 0.008) and creatinine clearance (p = 0.001). After HT, patients at the INTERMACS 1 level had a higher incidence of primary graft failure (p = 0.03) and postoperative need for renal replacement therapy (p = 0.004), and their long-term survival was lower than patients at the INTERMACS 2 (log rank 5.1, p = 0.023; HR 3.1, IC 95 % 1.1-8.8) and INTERMACS 3-4 level (log rank 6.1, p = 0.013; HR 6.8, IC 95 % 1.2-39.1).

Conclusions

Our results suggest that the INTERMACS scale may be a useful tool to stratify postoperative prognosis after urgent HT.