Preoperative INTERMACS profiles determine postoperative outcomes in critically ill patients undergoing emergency heart transplantation: analysis of the Spanish National Heart Transplant Registry
Postoperative outcomes of patients with advanced heart failure undergoing ventricular assist device implantation are strongly influenced by their preoperative Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles. We sought to investigate whether a similar associati...
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| Veröffentlicht in: | Circulation. Heart failure 2013-07, Vol.6 (4), p.763-772 |
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| creator | Barge-Caballero, Eduardo Segovia-Cubero, Javier Almenar-Bonet, Luis Gonzalez-Vilchez, Francisco Villa-Arranz, Adolfo Delgado-Jimenez, Juan Lage-Galle, Ernesto Perez-Villa, Felix Lambert-Rodríguez, Jose L Manito-Lorite, Nicolas Arizon-Del Prado, Jose M Brossa-Loidi, Vicens Pascual-Figal, Domingo Fuente-Galan, Luis De la Sanz-Julve, Marisa Muñiz-Garcia, Javier Crespo-Leiro, Marisa |
| description | Postoperative outcomes of patients with advanced heart failure undergoing ventricular assist device implantation are strongly influenced by their preoperative Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles. We sought to investigate whether a similar association exists in patients undergoing emergency heart transplantation.
By means of the Spanish National Heart Transplant Registry database, we identified 704 adult patients treated with emergency heart transplantation in 15 Spanish centers between 2000 and 2009. Post-transplant outcomes were analyzed pertaining to patient preoperative INTERMACS profiles, which were retrospectively assigned by 2 blinded cardiologists. Before transplantation, INTERMACS profile 1 (critical cardiogenic shock) was present in 207 patients, INTERMACS profile 2 (progressive decline) in 291, INTERMACS profile 3 (inotropic dependence) in 176, and INTERMACS profile 4 (resting symptoms) was present in 30 patients. In-hospital postoperative mortality rates were, respectively, 43%, 26.8%, and 18% in patients with profiles 1, 2, and 3 to 4 (P |
| doi_str_mv | 10.1161/CIRCHEARTFAILURE.112.000237 |
| format | Article |
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By means of the Spanish National Heart Transplant Registry database, we identified 704 adult patients treated with emergency heart transplantation in 15 Spanish centers between 2000 and 2009. Post-transplant outcomes were analyzed pertaining to patient preoperative INTERMACS profiles, which were retrospectively assigned by 2 blinded cardiologists. Before transplantation, INTERMACS profile 1 (critical cardiogenic shock) was present in 207 patients, INTERMACS profile 2 (progressive decline) in 291, INTERMACS profile 3 (inotropic dependence) in 176, and INTERMACS profile 4 (resting symptoms) was present in 30 patients. In-hospital postoperative mortality rates were, respectively, 43%, 26.8%, and 18% in patients with profiles 1, 2, and 3 to 4 (P<0.001). INTERMACS 1 patients also presented the highest incidence of primary graft failure (1: 31.3%, 2: 22.3%, 3-4: 21.8%; P=0.03) and postoperative need for dialysis (1: 33.2%, 2: 18.9%, 3-4: 21.5%; P<0.001). Adjusted odds-ratios for in-hospital postoperative mortality were 4.38 (95% confidence interval, 2.51-7.66) for profile 1 versus 3 to 4, 2.49 (95% confidence interval, 1.56-3.97) for profile 1 versus 2, and 1.76 (95% confidence interval, 1.02-3.03) for profile 2 versus 3 to 4. Long-term survival after hospital discharge was not influenced by preoperative INTERMACS profiles.
Preoperative INTERMACS profiles determine outcomes after emergency heart transplantation. Results call for a change in policies related to the management of heart transplant candidates presenting with INTERMACS profiles 1 and 2.</description><identifier>ISSN: 1941-3289</identifier><identifier>EISSN: 1941-3297</identifier><identifier>DOI: 10.1161/CIRCHEARTFAILURE.112.000237</identifier><identifier>PMID: 23674362</identifier><language>eng</language><publisher>United States</publisher><subject>Adult ; Aged ; Assisted Circulation ; Critical Illness ; Emergency Medical Services ; Female ; Health Status ; Heart Transplantation - mortality ; Heart-Assist Devices ; Hospital Mortality ; Humans ; Intra-Aortic Balloon Pumping ; Male ; Middle Aged ; Outcome Assessment (Health Care) ; Patient Selection ; Registries ; Retrospective Studies ; Severity of Illness Index ; Spain ; Tissue and Organ Procurement ; Treatment Outcome</subject><ispartof>Circulation. Heart failure, 2013-07, Vol.6 (4), p.763-772</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c178t-cec5b08d83933468f3dcb2e0d8f5fe3ddb1587a915267bc5f2ab9a3c73bde0ac3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3673,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23674362$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Barge-Caballero, Eduardo</creatorcontrib><creatorcontrib>Segovia-Cubero, Javier</creatorcontrib><creatorcontrib>Almenar-Bonet, Luis</creatorcontrib><creatorcontrib>Gonzalez-Vilchez, Francisco</creatorcontrib><creatorcontrib>Villa-Arranz, Adolfo</creatorcontrib><creatorcontrib>Delgado-Jimenez, Juan</creatorcontrib><creatorcontrib>Lage-Galle, Ernesto</creatorcontrib><creatorcontrib>Perez-Villa, Felix</creatorcontrib><creatorcontrib>Lambert-Rodríguez, Jose L</creatorcontrib><creatorcontrib>Manito-Lorite, Nicolas</creatorcontrib><creatorcontrib>Arizon-Del Prado, Jose M</creatorcontrib><creatorcontrib>Brossa-Loidi, Vicens</creatorcontrib><creatorcontrib>Pascual-Figal, Domingo</creatorcontrib><creatorcontrib>Fuente-Galan, Luis De la</creatorcontrib><creatorcontrib>Sanz-Julve, Marisa</creatorcontrib><creatorcontrib>Muñiz-Garcia, Javier</creatorcontrib><creatorcontrib>Crespo-Leiro, Marisa</creatorcontrib><title>Preoperative INTERMACS profiles determine postoperative outcomes in critically ill patients undergoing emergency heart transplantation: analysis of the Spanish National Heart Transplant Registry</title><title>Circulation. Heart failure</title><addtitle>Circ Heart Fail</addtitle><description>Postoperative outcomes of patients with advanced heart failure undergoing ventricular assist device implantation are strongly influenced by their preoperative Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles. We sought to investigate whether a similar association exists in patients undergoing emergency heart transplantation.
By means of the Spanish National Heart Transplant Registry database, we identified 704 adult patients treated with emergency heart transplantation in 15 Spanish centers between 2000 and 2009. Post-transplant outcomes were analyzed pertaining to patient preoperative INTERMACS profiles, which were retrospectively assigned by 2 blinded cardiologists. Before transplantation, INTERMACS profile 1 (critical cardiogenic shock) was present in 207 patients, INTERMACS profile 2 (progressive decline) in 291, INTERMACS profile 3 (inotropic dependence) in 176, and INTERMACS profile 4 (resting symptoms) was present in 30 patients. In-hospital postoperative mortality rates were, respectively, 43%, 26.8%, and 18% in patients with profiles 1, 2, and 3 to 4 (P<0.001). INTERMACS 1 patients also presented the highest incidence of primary graft failure (1: 31.3%, 2: 22.3%, 3-4: 21.8%; P=0.03) and postoperative need for dialysis (1: 33.2%, 2: 18.9%, 3-4: 21.5%; P<0.001). Adjusted odds-ratios for in-hospital postoperative mortality were 4.38 (95% confidence interval, 2.51-7.66) for profile 1 versus 3 to 4, 2.49 (95% confidence interval, 1.56-3.97) for profile 1 versus 2, and 1.76 (95% confidence interval, 1.02-3.03) for profile 2 versus 3 to 4. Long-term survival after hospital discharge was not influenced by preoperative INTERMACS profiles.
Preoperative INTERMACS profiles determine outcomes after emergency heart transplantation. Results call for a change in policies related to the management of heart transplant candidates presenting with INTERMACS profiles 1 and 2.</description><subject>Adult</subject><subject>Aged</subject><subject>Assisted Circulation</subject><subject>Critical Illness</subject><subject>Emergency Medical Services</subject><subject>Female</subject><subject>Health Status</subject><subject>Heart Transplantation - mortality</subject><subject>Heart-Assist Devices</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Intra-Aortic Balloon Pumping</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Outcome Assessment (Health Care)</subject><subject>Patient Selection</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Severity of Illness Index</subject><subject>Spain</subject><subject>Tissue and Organ Procurement</subject><subject>Treatment Outcome</subject><issn>1941-3289</issn><issn>1941-3297</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkdtuEzEQhi0EoqXwCsgSN9yk9SF7gqtolZJIoaBter3y2rOJkddebC_Svh5PhmnaIHE1o5nvnxnNj9AHSq4pzelNvW3qzXrV7G9X291Ds05Vdk0IYbx4gS5ptaQLzqri5Tkvqwv0JoQfhOQsy6rX6ILxvFjynF2i3989uBG8iPoX4O3dft18XdX3ePSu1wYCVhDBD9oCHl2I_1A3RemGBGiLpddRS2HMjLUxeEwE2BjwZBX4g9P2gGFIGVg54yMIH3H0wobRCBsT7OwnLKwwc9ABux7HI-D7UVgdjvjusS8M3jzq9mcdbuCgQ_TzW_SqFybAu6d4hR5u1_t6s9h9-7KtV7uFpEUZFxJk1pFSlbzifJmXPVeyY0BU2Wc9cKU6mpWFqGjG8qKTWc9EVwkuC94pIELyK_TxNDf95ucEIbaDDhJMOgbcFFq6JJSUVcZ4Qj-fUOldCB76dvR6EH5uKWn_mtj-b2KqsvZkYlK_f1o0dQOos_bZNf4HQnihqA</recordid><startdate>201307</startdate><enddate>201307</enddate><creator>Barge-Caballero, Eduardo</creator><creator>Segovia-Cubero, Javier</creator><creator>Almenar-Bonet, Luis</creator><creator>Gonzalez-Vilchez, Francisco</creator><creator>Villa-Arranz, Adolfo</creator><creator>Delgado-Jimenez, Juan</creator><creator>Lage-Galle, Ernesto</creator><creator>Perez-Villa, Felix</creator><creator>Lambert-Rodríguez, Jose L</creator><creator>Manito-Lorite, Nicolas</creator><creator>Arizon-Del Prado, Jose M</creator><creator>Brossa-Loidi, Vicens</creator><creator>Pascual-Figal, Domingo</creator><creator>Fuente-Galan, Luis De la</creator><creator>Sanz-Julve, Marisa</creator><creator>Muñiz-Garcia, Javier</creator><creator>Crespo-Leiro, Marisa</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201307</creationdate><title>Preoperative INTERMACS profiles determine postoperative outcomes in critically ill patients undergoing emergency heart transplantation: analysis of the Spanish National Heart Transplant Registry</title><author>Barge-Caballero, Eduardo ; Segovia-Cubero, Javier ; Almenar-Bonet, Luis ; Gonzalez-Vilchez, Francisco ; Villa-Arranz, Adolfo ; Delgado-Jimenez, Juan ; Lage-Galle, Ernesto ; Perez-Villa, Felix ; Lambert-Rodríguez, Jose L ; Manito-Lorite, Nicolas ; Arizon-Del Prado, Jose M ; Brossa-Loidi, Vicens ; Pascual-Figal, Domingo ; Fuente-Galan, Luis De la ; Sanz-Julve, Marisa ; Muñiz-Garcia, Javier ; Crespo-Leiro, Marisa</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c178t-cec5b08d83933468f3dcb2e0d8f5fe3ddb1587a915267bc5f2ab9a3c73bde0ac3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Assisted Circulation</topic><topic>Critical Illness</topic><topic>Emergency Medical Services</topic><topic>Female</topic><topic>Health Status</topic><topic>Heart Transplantation - mortality</topic><topic>Heart-Assist Devices</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Intra-Aortic Balloon Pumping</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Outcome Assessment (Health Care)</topic><topic>Patient Selection</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Severity of Illness Index</topic><topic>Spain</topic><topic>Tissue and Organ Procurement</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Barge-Caballero, Eduardo</creatorcontrib><creatorcontrib>Segovia-Cubero, Javier</creatorcontrib><creatorcontrib>Almenar-Bonet, Luis</creatorcontrib><creatorcontrib>Gonzalez-Vilchez, Francisco</creatorcontrib><creatorcontrib>Villa-Arranz, Adolfo</creatorcontrib><creatorcontrib>Delgado-Jimenez, Juan</creatorcontrib><creatorcontrib>Lage-Galle, Ernesto</creatorcontrib><creatorcontrib>Perez-Villa, Felix</creatorcontrib><creatorcontrib>Lambert-Rodríguez, Jose L</creatorcontrib><creatorcontrib>Manito-Lorite, Nicolas</creatorcontrib><creatorcontrib>Arizon-Del Prado, Jose M</creatorcontrib><creatorcontrib>Brossa-Loidi, Vicens</creatorcontrib><creatorcontrib>Pascual-Figal, Domingo</creatorcontrib><creatorcontrib>Fuente-Galan, Luis De la</creatorcontrib><creatorcontrib>Sanz-Julve, Marisa</creatorcontrib><creatorcontrib>Muñiz-Garcia, Javier</creatorcontrib><creatorcontrib>Crespo-Leiro, Marisa</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation. Heart failure</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Barge-Caballero, Eduardo</au><au>Segovia-Cubero, Javier</au><au>Almenar-Bonet, Luis</au><au>Gonzalez-Vilchez, Francisco</au><au>Villa-Arranz, Adolfo</au><au>Delgado-Jimenez, Juan</au><au>Lage-Galle, Ernesto</au><au>Perez-Villa, Felix</au><au>Lambert-Rodríguez, Jose L</au><au>Manito-Lorite, Nicolas</au><au>Arizon-Del Prado, Jose M</au><au>Brossa-Loidi, Vicens</au><au>Pascual-Figal, Domingo</au><au>Fuente-Galan, Luis De la</au><au>Sanz-Julve, Marisa</au><au>Muñiz-Garcia, Javier</au><au>Crespo-Leiro, Marisa</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Preoperative INTERMACS profiles determine postoperative outcomes in critically ill patients undergoing emergency heart transplantation: analysis of the Spanish National Heart Transplant Registry</atitle><jtitle>Circulation. Heart failure</jtitle><addtitle>Circ Heart Fail</addtitle><date>2013-07</date><risdate>2013</risdate><volume>6</volume><issue>4</issue><spage>763</spage><epage>772</epage><pages>763-772</pages><issn>1941-3289</issn><eissn>1941-3297</eissn><abstract>Postoperative outcomes of patients with advanced heart failure undergoing ventricular assist device implantation are strongly influenced by their preoperative Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles. We sought to investigate whether a similar association exists in patients undergoing emergency heart transplantation.
By means of the Spanish National Heart Transplant Registry database, we identified 704 adult patients treated with emergency heart transplantation in 15 Spanish centers between 2000 and 2009. Post-transplant outcomes were analyzed pertaining to patient preoperative INTERMACS profiles, which were retrospectively assigned by 2 blinded cardiologists. Before transplantation, INTERMACS profile 1 (critical cardiogenic shock) was present in 207 patients, INTERMACS profile 2 (progressive decline) in 291, INTERMACS profile 3 (inotropic dependence) in 176, and INTERMACS profile 4 (resting symptoms) was present in 30 patients. In-hospital postoperative mortality rates were, respectively, 43%, 26.8%, and 18% in patients with profiles 1, 2, and 3 to 4 (P<0.001). INTERMACS 1 patients also presented the highest incidence of primary graft failure (1: 31.3%, 2: 22.3%, 3-4: 21.8%; P=0.03) and postoperative need for dialysis (1: 33.2%, 2: 18.9%, 3-4: 21.5%; P<0.001). Adjusted odds-ratios for in-hospital postoperative mortality were 4.38 (95% confidence interval, 2.51-7.66) for profile 1 versus 3 to 4, 2.49 (95% confidence interval, 1.56-3.97) for profile 1 versus 2, and 1.76 (95% confidence interval, 1.02-3.03) for profile 2 versus 3 to 4. Long-term survival after hospital discharge was not influenced by preoperative INTERMACS profiles.
Preoperative INTERMACS profiles determine outcomes after emergency heart transplantation. Results call for a change in policies related to the management of heart transplant candidates presenting with INTERMACS profiles 1 and 2.</abstract><cop>United States</cop><pmid>23674362</pmid><doi>10.1161/CIRCHEARTFAILURE.112.000237</doi><tpages>10</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1941-3289 |
| ispartof | Circulation. Heart failure, 2013-07, Vol.6 (4), p.763-772 |
| issn | 1941-3289 1941-3297 |
| language | eng |
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| source | MEDLINE; American Heart Association; EZB-FREE-00999 freely available EZB journals |
| subjects | Adult Aged Assisted Circulation Critical Illness Emergency Medical Services Female Health Status Heart Transplantation - mortality Heart-Assist Devices Hospital Mortality Humans Intra-Aortic Balloon Pumping Male Middle Aged Outcome Assessment (Health Care) Patient Selection Registries Retrospective Studies Severity of Illness Index Spain Tissue and Organ Procurement Treatment Outcome |
| title | Preoperative INTERMACS profiles determine postoperative outcomes in critically ill patients undergoing emergency heart transplantation: analysis of the Spanish National Heart Transplant Registry |
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