title: The HeartMate II Risk Score: An Adjusted Score for Evaluation of All Continuous-Flow Left Ventricular Assist Devices.
abstract: The aim of this study was to evaluate the performance of an adjusted HeartMate II risk score (HMRS) in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS; n = 9,733) and in HeartWare Ventricular Assist Device (HVAD) bridge to transplant (BTT) trial patients (n = 360). Interagency Registry for Mechanically Assisted Circulatory Support data were used to calculate an adjusted HMRS, omitting center volume, for all patients on continuous-flow left ventricular assist device (LVAD) support. Ninety day mortality was then evaluated in INTERMACS and HVAD-BTT patients. Four risk groups were identified based on INTERMACS patient-adjusted HMRS: very low (<5%, 90 day mortality; score <0.20), low (5-10%, 90 day mortality; score 0.20-1.97), medium (10-20%, 90 day mortality; score 1.98-4.48), and high risk (>20%, 90 day mortality; score >4.48). Within INTERMACS, there were significant differences in survival between all-adjusted HMRS risk groups (p < 0.001 in pairwise comparisons). Controlling for known mortality correlates, the adjusted HMRS mortality hazard ratio was 1.19 (1.25-1.23) per unit HMRS increase. The HVAD cohort was a low-risk cohort with 90 day survivals for very low-, low-, and medium-risk patients of 100%, 97 ± 1.1%, and 90 ± 3.6%, respectively (p = 0.007). Patients in the very low- and low-risk group had significantly improved survival compared with medium-risk patients, respectively (both p < 0.05). The adjusted HMRS appropriately risk stratified a large cohort of INTERMACS patients and was predictive of survival in HeartWare-supported patients.
authors.affiliation: From the *Division of Cardiology, St. Vincent Heart Center of Indiana, Indianapolis, Indiana; †Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, Michigan; ‡Division of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky; and §Cardiothoracic Surgery, St. Vincent Heart Center of Indiana, Indianapolis, Indiana.
authors.forename: Jennifer Ann
authors.initials: JA
authors.lastname: Cowger
authors.forename: Lindsay
authors.initials: L
authors.lastname: Castle
authors.forename: Keith David
authors.initials: KD
authors.lastname: Aaronson
authors.forename: Mark S
authors.initials: MS
authors.lastname: Slaughter
authors.forename: Sina
authors.initials: S
authors.lastname: Moainie
authors.forename: Mary
authors.initials: M
authors.lastname: Walsh
authors.forename: Christopher
authors.initials: C
authors.lastname: Salerno
mesh_terms: D000368:Aged; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012306:Risk