Author + information
- Received May 5, 2016
- Revision received July 13, 2016
- Accepted July 20, 2016
- Published online December 1, 2016.
- Luigi Adamo, MD, PhDa,
- Yuanyuan Tang, PhDb,
- Michael E. Nassif, MDa,b,
- Eric Novak, MSa,
- Philip G. Jones, MSb,
- Shane LaRue, MD, MPHSa,
- John A. Spertus, MDb,c and
- Douglas L. Mann, MDa,∗ ()
- aCardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
- bSaint Luke’s Mid America Heart Institute, Kansas City, Missouri
- cUniversity of Missouri, Kansas City, Missouri
- ↵∗Reprint requests and correspondence:
Dr. Douglas L. Mann, Division of Cardiology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St. Louis, Missouri 63110.
Objectives This study sought to assess the performance of the HeartMate Risk Score (HMRS) in a large multicenter cohort, with a focus on its performance as a function of disease severity.
Background The HMRS has been proposed as a simple tool for risk stratification of LVAD recipients, but subsequent studies have challenged its validity.
Methods We performed a retrospective, longitudinal, comparative study using the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) database. The HMRS was calculated for each patient and its association with mortality was assessed using Cox models, including a pre-specified interaction by INTERMACS profile groups (1 vs. 2 vs. 3 vs 4+).
Results Among 10,847 patients with a mean age of 57.0 ± 12.9 years, 78.9 % were male; and 14.1%, 37.4%, 30.4%, and 18.2% were in INTERMACS profile groups 1, 2, 3, and ≥4, respectively. The HMRS showed moderate discrimination for both short-term (90-day, C-index 0.62) and long-term (2-years, C-index 0.60) mortality, with no significant difference between axial and centrifugal devices. Patients in the highest HMRS group had a relative risk of 90-day mortality 2.8 times greater than those in the lowest HMRS group (13.0% vs. 4.7%; p < 0.001). Importantly, the relative risks of higher HMRS scores were similar across INTERMACS profile groups, with subgroups of patients in INTERMACS profile 1 and 2 having comparable or lower mortality than some in INTERMACS profile 4+.
Conclusions The HMRS is a valid means of risk-stratifying patients across all INTERMACS profiles and may be superior to traditional INTERMACS classification. Risk stratification with the HMRS showed that patients within each INTERMACS profile groups have a wide spectrum of mortality risk and low INTERMACS profiles should therefore not be considered a contraindication to mechanical support.
Data collection for this work was supported in whole or in part by the National Heart, Lung and Blood Institute, National Institutes of Health, Department of Health and Human Services under Contract No. HHSN268201100025C. The content is solely the responsibility of the author(s) and does not necessarily represent the official views of the INTERMACS or the National Institutes of Health. Dr. Spertus is the Founder and an equity holder in Health Outcomes Sciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 5, 2016.
- Revision received July 13, 2016.
- Accepted July 20, 2016.
- American College of Cardiology Foundation