心脏移植后 1 年死亡率的桥接至移植左心室辅助装置评分的推导和验证。BTT-LVAD 评分。
Derivation and validation of the bridge to transplantation with left ventricular assist device score for 1 year mortality after heart transplantation. The BTT-LVAD score.
机构信息
Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA.
Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.
出版信息
Int J Artif Organs. 2022 May;45(5):470-477. doi: 10.1177/03913988221082690. Epub 2022 Apr 1.
BACKGROUND
To derive and validate a risk score that accurately predicts 1-year mortality after heart transplantation (HT) in patients bridged to transplant (BTT) with a left ventricular assist device (LVAD).
METHODS
The UNOS database was queried to identify patients BTT with an LVAD between 2008 and 2018. Patients with ⩾1-year follow up were randomly divided into derivation (70%) and validation (30%) cohorts. The primary endpoint was 1-year mortality. A simple additive risk score was developed based on the odds of 1-year mortality after HT. Risk groups were created, and survival was estimated and compared.
RESULTS
A total of 7759 patients were randomly assigned to derivation ( = 5431) and validation ( = 2328) cohorts. One-year post-transplant mortality was 9.8% ( = 760). A 33-point scoring was created from six recipient variables and two donor variables. Risk groups were classified as low (0-5), intermediate (6-10), and high (>10). In the validation cohort, the predicted 1-year mortality was significantly higher in the high-risk group than the intermediate and low-risk groups, 14.7% versus 9% versus 6.1% respectively (log-rank test: < 0.0001).
CONCLUSION
The BTT-LVAD Score can serve as a clinical decision tool to guide therapeutic decisions in advanced heart failure patients.
背景
为了开发和验证一种风险评分，以准确预测心脏移植（HT）桥接左心室辅助装置（LVAD）的患者的 1 年死亡率。
方法
UNOS 数据库被查询以确定在 2008 年至 2018 年期间使用 LVAD 桥接移植（BTT）的患者。具有 ⩾1 年随访的患者被随机分为推导（70%）和验证（30%）队列。主要终点是 1 年死亡率。根据 HT 后 1 年死亡率的几率，开发了一个简单的附加风险评分。创建了风险组，并估计和比较了生存率。
结果
共有 7759 名患者被随机分配到推导（=5431）和验证（=2328）队列。移植后 1 年死亡率为 9.8%（=760）。从六个受体变量和两个供体变量创建了 33 分评分。风险组分为低（0-5）、中（6-10）和高（>10）。在验证队列中，高风险组的预测 1 年死亡率明显高于中风险组和低风险组，分别为 14.7%、9%和 6.1%（对数秩检验：<0.0001）。
结论
BTT-LVAD 评分可作为临床决策工具，指导晚期心力衰竭患者的治疗决策。
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