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Usefulness of the INTERMACS Scale for predicting outcomes after urgent heart transplantation
Eduardo Barge-Caballero1, María J Paniagua-Martín, Raquel Marzoa-Rivas
1Unidad de Trasplante Cardiaco, Hospital Universitario de A Coruña, A Coruña, España. blargesbueno@hotmail.com
Insights
The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) scale effectively predicts outcomes for patients needing urgent heart transplantation. Lower INTERMACS scores correlate with poorer prognosis and reduced long-term survival post-transplant.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Informatics
Background:
- Urgent heart transplantation (HT) is a critical procedure for end-stage heart failure.
- Accurate prognostic tools are essential for patient management and resource allocation.
- The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) scale categorizes patient acuity.
Purpose of the Study:
- To evaluate the prognostic significance of the INTERMACS scale in patients undergoing urgent heart transplantation.
- To determine if INTERMACS levels can stratify risk and predict outcomes after urgent HT.
Main Methods:
- Retrospective analysis of 111 patients who received urgent heart transplantation.
- Patients were classified into three INTERMACS levels (1, 2, 3-4) based on pre-transplant clinical status.
- Comparison of clinical characteristics and post-transplant outcomes across INTERMACS levels.
Main Results:
- Patients in INTERMACS level 1 exhibited higher rates of ischemic heart disease, post-cardiothomy shock, and preoperative support (mechanical ventilation, IABP, VADs).
- INTERMACS 1 patients showed worse preoperative physiological markers (higher CVP, AST, ALT, creatinine; lower hemoglobin, creatinine clearance).
- Higher INTERMACS 1 incidence of primary graft failure, need for renal replacement therapy, and significantly lower long-term survival compared to INTERMACS 2 and 3-4 levels.
Conclusions:
- The INTERMACS scale is a valuable tool for stratifying postoperative prognosis in patients undergoing urgent heart transplantation.
- Utilizing the INTERMACS scale can aid in identifying high-risk patients and optimizing perioperative care.
- Further validation of the INTERMACS scale in urgent HT populations is warranted.
Introduction And Objectives:
Our aim was to assess the prognostic value of the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) scale in patients undergoing urgent heart transplantation (HT).
Methods:
Retrospective analysis of 111 patients treated with urgent HT at our institution from April, 1991 to October, 2009. Patients were retrospectively assigned to three levels of the INTERMACS scale according to their clinical status before HT.
Results:
Patients at the INTERMACS 1 level (n=31) more frequently had ischemic heart disease (P=.03) and post-cardiothomy shock (P=.02) than patients at the INTERMACS 2 (n=55) and INTERMACS 3-4 (n=25) levels. Patients at the INTERMACS 1 level showed higher preoperative catecolamin doses (P=.001), a higher frequency of use of mechanical ventilation (P<.001), intraaortic balloon (P=.002) and ventricular assist devices (P=.002), and a higher frequency of preoperative infection (P=.015). The INTERMACS 1 group also presented higher central venous pressure (P=.02), AST (P=.002), ALT (P=.006) and serum creatinine (P<.001), and lower hemoglobin (P=.008) and creatinine clearance (P=.001). After HT, patients at the INTERMACS 1 level had a higher incidence of primary graft failure (P=.03) and postoperative need for renal replacement therapy (P=.004), and their long-term survival was lower than patients at the INTERMACS 2 (log rank 5.1, P=.023; HR 3.1, IC 95% 1.1-8.8) and INTERMACS 3-4 level (log rank 6.1, p=0.013; HR 6.8, IC 95% 1.2-39.1).
Conclusions:
Our results suggest that the INTERMACS scale may be a useful tool to stratify postoperative prognosis after urgent HT.
