Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Ann Thorac Surg. 2009 Dec;88(6):1889-96. doi: 10.1016/j.athoracsur.2009.08.011.
The Leitz-Miller (LM), Columbia (COL), Acute Physiology and Chronic Health Evaluation II (APACHE II), Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS), and Seattle Heart Failure Model (SHFM) risk scores have been used to risk stratify patients with pulsatile-flow left ventricular assist devices (LVAD). We assessed the predictive ability of these scores in a cohort of continuous-flow LVAD patients.
Preoperative scores were calculated from prospective data of patients who received continuous-flow LVADs between June 2000 and May 2009. Cox proportional hazard analysis assessed the effect of preoperative variables and scores on 30-day, 90-day, and 1-year mortality. Patients were stratified by score into low- and high-risk groups. Survival was modeled using the Kaplan-Meier method.
During the study period, 86 continuous-flow LVADs were implanted. The mean (+/- standard deviation) preoperative scores were: COL, 1.05 +/- 1.59; LM, 11.9 +/- 5.4; APACHE II, 15.6 +/- 4.3; INTERMACS, 2.64 +/- 1.01; and SHFM, 2.97 +/- 1 .42. On univariate analysis, the SHFM score best differentiated low- and high-risk patients at all mortality end points; the INTERMACS and APACHE II scores were predictive for 90-day and 1-year mortality. On multivariable analysis, SHFM (hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.02 to 2.21; p = 0.04) and APACHE II (HR, 1.10; 95% CI, 1.01 to 1.21; p = 0.04) predicted 1-year mortality.
Among the LM, COL, APACHE II, INTERMACS, and SHFM scores, the best predictor of mortality in a single institutional cohort of continuous-flow LVAD patients was the SHFM score.
莱茨-米勒（LM）、哥伦比亚（COL）、急性生理学和慢性健康评估 II（APACHE II）、机械辅助循环支持机构间注册（INTERMACS）和西雅图心力衰竭模型（SHFM）风险评分已被用于对搏动血流左心室辅助装置（LVAD）患者进行风险分层。我们评估了这些评分在连续血流 LVAD 患者队列中的预测能力。
从 2000 年 6 月至 2009 年 5 月接受连续血流 LVAD 的患者的前瞻性数据中计算术前评分。Cox 比例风险分析评估了术前变量和评分对 30 天、90 天和 1 年死亡率的影响。根据评分将患者分为低危和高危组。使用 Kaplan-Meier 方法对生存进行建模。
在研究期间，植入了 86 个连续血流 LVAD。平均（+/-标准差）术前评分如下：COL，1.05 +/- 1.59；LM，11.9 +/- 5.4；APACHE II，15.6 +/- 4.3；INTERMACS，2.64 +/- 1.01；SHFM，2.97 +/- 1.42。在单变量分析中，SHFM 评分在所有死亡率终点上最好地区分了低危和高危患者；INTERMACS 和 APACHE II 评分可预测 90 天和 1 年死亡率。多变量分析显示，SHFM（危险比 [HR]，1.50；95%置信区间 [CI]，1.02 至 2.21；p = 0.04）和 APACHE II（HR，1.10；95% CI，1.01 至 1.21；p = 0.04）预测 1 年死亡率。
在 LM、COL、APACHE II、INTERMACS 和 SHFM 评分中，SHFM 评分是单一机构连续血流 LVAD 患者死亡率的最佳预测指标。
