title: Usefulness of the INTERMACS Scale for predicting outcomes after urgent heart transplantation.
abstract: OBJECTIVE
  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=.03) and post-cardiothomy shock (P=.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=.001), a higher frequency of use of mechanical ventilation (P<.001), intraaortic balloon (P=.002) and ventricular assist devices (P=.002), and a higher frequency of preoperative infection (P=.015). The INTERMACS 1 group also presented higher central venous pressure (P=.02), AST (P=.002), ALT (P=.006) and serum creatinine (P<.001), and lower hemoglobin (P=.008) and creatinine clearance (P=.001). After HT, patients at the INTERMACS 1 level had a higher incidence of primary graft failure (P=.03) and postoperative need for renal replacement therapy (P=.004), and their long-term survival was lower than patients at the INTERMACS 2 (log rank 5.1, P=.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.
authors.affiliation: Unidad de Trasplante Cardiaco, Hospital Universitario de A Coruña, A Coruña, España. blargesbueno@hotmail.com
authors.forename: Eduardo
authors.initials: E
authors.lastname: Barge-Caballero
authors.forename: María J
authors.initials: MJ
authors.lastname: Paniagua-Martín
authors.forename: Raquel
authors.initials: R
authors.lastname: Marzoa-Rivas
authors.forename: Rosa
authors.initials: R
authors.lastname: Campo-Pérez
authors.forename: José Ángel
authors.initials: JÁ
authors.lastname: Rodríguez-Fernández
authors.forename: Alberto
authors.initials: A
authors.lastname: Pérez-Pérez
authors.forename: Lourdes
authors.initials: L
authors.lastname: García-Bueno
authors.forename: Paula
authors.initials: P
authors.lastname: Blanco-Canosa
authors.forename: Zulaika Grille
authors.initials: ZG
authors.lastname: Cancela
authors.forename: Miguel
authors.initials: M
authors.lastname: Solla-Buceta
authors.forename: Alberto
authors.initials: A
authors.lastname: Juffé-Stein
authors.forename: José M
authors.initials: JM
authors.lastname: Herrera-Noreña
authors.forename: José J
authors.initials: JJ
authors.lastname: Cuenca-Castillo
authors.forename: Javier
authors.initials: J
authors.lastname: Muñiz
authors.forename: Alfonso
authors.initials: A
authors.lastname: Castro-Beiras
authors.forename: María G
authors.initials: MG
authors.lastname: Crespo-Leiro
mesh_terms: D004638:Emergency Treatment; D005260:Female; D006333:Heart Failure / Q000145:classification* / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome