title: Risk scores for predicting mortality after surgical ventricular reconstruction for ischemic cardiomyopathy: results of a Japanese multicenter study.
abstract: OBJECTIVE
  Surgical ventricular reconstruction has been believed to be beneficial for those with ischemic cardiomyopathy. However, the effectiveness of surgical ventricular reconstruction was not proved by a large-scale trial, and no report has clearly demonstrated the exact indications and limitations of surgical ventricular reconstruction. The purpose of this study was to elucidate predictive factors of mortality after surgical ventricular reconstruction and to develop a prognostic model by calculating risk scores.
  
  
  METHODS
  The study subjects were 596 patients who underwent surgical ventricular reconstruction for chronic ischemic heart failure in 11 Japanese cardiovascular hospitals between 2000 and 2010. Potential predictors of postoperative mortality were assessed using the Cox proportional hazards model, and a risk score was calculated.
  
  
  RESULTS
  Forty-one patients died before discharge, and 81 patients died during a mean follow-up time of 2.9 years. Four independent predictors of mortality were identified: age, Interagency Registry for Mechanically Assisted Circulatory Support profile, left ventricular ejection fraction, and severity of mitral regurgitation. Each variable was assigned a number of points proportional to its regression coefficient. A risk score was calculated using the point scores for each patient, and 3 risk groups were developed: a low-risk group (0-4 points), an intermediate-risk group (5-6 points), and a high-risk group (7-12 points). Their 3-year survivals were 93%, 81%, and 44%, respectively (log-rank P < .001). Harrell's C-index of the predictive model was 0.69.
  
  
  CONCLUSIONS
  A simple prognostic model was developed to predict mortality after surgical ventricular reconstruction. It can be useful in clinical practice to select treatment options for ischemic heart failure.
authors: Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Satoru
authors: S
authors: Wakasa
authors: Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. Electronic address: ymatsui@med.hokudai.ac.jp.
authors: Yoshiro
authors: Y
authors: Matsui
authors: Division of Cardiovascular Surgery, Hayama Heart Center, Hayama, Japan.
authors: Tadashi
authors: T
authors: Isomura
authors: Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan.
authors: Shuichiro
authors: S
authors: Takanashi
authors: Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors: Atsushi
authors: A
authors: Yamaguchi
authors: Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan.
authors: Tatsuhiko
authors: T
authors: Komiya
authors: Department of Cardiovascular Surgery, Tokai University School of Medicine, Isehara, Japan.
authors: Yasunori
authors: Y
authors: Cho
authors: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors: Junjiro
authors: J
authors: Kobayashi
authors: Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Hitoshi
authors: H
authors: Yaku
authors: Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan.
authors: Kiyokazu
authors: K
authors: Kokaji
authors: Department of Cardiovascular Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
authors: Hirokuni
authors: H
authors: Arai
authors: Division of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Yoshiki
authors: Y
authors: Sawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D009202:Cardiomyopathies / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D003661:Decision Support Techniques; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D016016:Proportional Hazards Models; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome