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Comprehensive Analysis of Stroke in the Long-Term Cohort of the MOMENTUM 3 Study
Paolo C Colombo1, Mandeep R Mehra2, Daniel J Goldstein3
1Columbia University Medical Center, New York, NY (P.C.C.).
Circulation
|December 28, 2018
Summary
The HeartMate 3 (HM3) pump significantly reduces long-term stroke events in advanced heart failure patients compared to the HeartMate II (HMII). Stroke occurrence, regardless of type or severity, predicts poorer 2-year survival rates.
Area of Science:
- Cardiology
- Neurology
- Biomedical Engineering
Background:
- The MOMENTUM 3 study previously indicated fewer strokes with the HeartMate 3 (HM3) left ventricular assist device (LVAD) compared to the HeartMate II (HMII).
- This analysis provides a detailed examination of stroke events over a 2-year period in patients receiving HM3 or HMII support.
Purpose of the Study:
- To comprehensively analyze the longitudinal occurrence, clinical correlates, patterns, and outcomes of stroke events in patients supported by HM3 versus HMII devices.
- To identify predictors of stroke and assess the impact of stroke on long-term survival.
Main Methods:
- A randomized controlled trial comparing HM3 (centrifugal-flow) and HMII (axial-flow) pumps in advanced heart failure patients.
- Multivariable analyses were used to assess baseline and postimplantation correlates of stroke.
- Longitudinal patterns of stroke (hemorrhagic vs. ischemic, disabling vs. nondisabling) and their association with 2-year outcomes were determined.
Main Results:
- In 361 patients, 65 strokes occurred. Long-term stroke incidence (181-730 days) was 3.3 times lower with HM3 (0.04 events/patient-year) versus HMII (0.13 events/patient-year).
- HM3 pump treatment was the sole independent predictor of reduced stroke events; blood pressure and antithrombotic regimens showed no direct association.
- Stroke events significantly reduced 2-year survival (43-57%) compared to patients without stroke (85%).
Conclusions:
- The HM3 pump demonstrates a significant reduction in stroke rates, particularly in the long term (>6 months), compared to the HMII device.
- Stroke occurrence, irrespective of type or severity, is a significant predictor of poor 2-year clinical outcomes in LVAD patients.
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