title: Preoperative INTERMACS profiles determine postoperative outcomes in critically ill patients undergoing emergency heart transplantation: analysis of the Spanish National Heart Transplant Registry.
abstract: BACKGROUND
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Heart Transplant Unit, Hospital Universitario A Coruña, A Coruña, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Barge-Caballero
authors.forename: Javier
authors.initials: J
authors.lastname: Segovia-Cubero
authors.forename: Luis
authors.initials: L
authors.lastname: Almenar-Bonet
authors.forename: Francisco
authors.initials: F
authors.lastname: Gonzalez-Vilchez
authors.forename: Adolfo
authors.initials: A
authors.lastname: Villa-Arranz
authors.forename: Juan
authors.initials: J
authors.lastname: Delgado-Jimenez
authors.forename: Ernesto
authors.initials: E
authors.lastname: Lage-Galle
authors.forename: Felix
authors.initials: F
authors.lastname: Perez-Villa
authors.forename: Jose L
authors.initials: JL
authors.lastname: Lambert-Rodríguez
authors.forename: Nicolas
authors.initials: N
authors.lastname: Manito-Lorite
authors.forename: Jose M
authors.initials: JM
authors.lastname: Arizon-Del Prado
authors.forename: Vicens
authors.initials: V
authors.lastname: Brossa-Loidi
authors.forename: Domingo
authors.initials: D
authors.lastname: Pascual-Figal
authors.forename: Luis De la
authors.initials: Lde L
authors.lastname: Fuente-Galan
authors.forename: Marisa
authors.initials: M
authors.lastname: Sanz-Julve
authors.forename: Javier
authors.initials: J
authors.lastname: Muñiz-Garcia
authors.forename: Marisa
authors.initials: M
authors.lastname: Crespo-Leiro
mesh_terms: D000328:Adult; D000368:Aged; D001243:Assisted Circulation; D016638:Critical Illness; D004632:Emergency Medical Services; D005260:Female; D006304:Health Status; D016027:Heart Transplantation / Q000401:mortality; D006353:Heart-Assist Devices; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013030:Spain; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome
keywords: prognosis; registries; transplantation