Development of a Transplantation Risk Index in Patients With Mechanical Circulatory Support: A Decision Support Tool.
Johnston LE, Grimm JC, et al.JACC Heart Failure 2016; 4(4): 277-286.
Aims
To create and validate a risk index specific to patients on mechanical circulatory support (MCS) that accurately predicts 1-year mortality after orthotopic heart transplantation (OHT) using the United Network for Organ Sharing (UNOS) database.
Interventions
The sample was randomly divided into 80% model derivation cohort and 20% validation cohort, and all plausible variables for predicting 1-year mortality were evaluated using univariate logistic regression in the derivation sample.
Participants
6,036 primary OHT patients aged ≥ 18 years
Outcomes
The primary outcome measured was 1-year mortality. Secondary outcomes measured were 90-day and 3-year mortality and overall survival time.
Follow-up
1-year
CET Conclusions
The authors have developed a risk index after transplantation in patients being supported by a mechanical circulatory device. They had prospectively collected an open cohort of 6,000 patients receiving circulatory support who underwent orthotopic heart transplantation between 2000 and 2013 and randomly separated them into a derivation (80%) and validation (20%) groups. From this they developed a 75 point scoring system using nine recipient and four donor variables. The findings suggested that this indeed was a good risk index and each 1 point increase in the risk index predicted approximately an 8% increase in the odds of one year mortality. This novel internally cross validated risk index actively predicted mortality in bridge to transplantation patients and should be a very useful addition to the armamentarium of clinicians caring for patients on mechanical circulatory support waiting for a heart transplant.
Quality notes
Quality assessment not appropriate
Trial registration
None