Open AccessPredicting Long Term Outcome in Patients Treated With Continuous Flow Left Ventricular Assist Device: The Penn—Columbia Risk Score
Author(s) -
Birati Edo Y.,
Hanff Thomas C.,
Maldonado Dawn,
Grandin E. Wilson,
Kennel Peter J.,
Mazurek Jeremy A.,
Vorovich Esther,
Seigerman Matthew,
Howard Jessica L.L.,
Acker Michael A.,
Naka Yoshifumi,
Wald Joyce,
Goldberg Lee R.,
Jessup Mariell,
Atluri Pavan,
Margulies Kenneth B.,
Schulze P. Christian,
Rame J. Eduardo
Publication year - 2018
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.117.006408
Subject(s) - medicine , proportional hazards model , hazard ratio , akaike information criterion , covariate , log rank test , survival analysis , concordance , univariate analysis , retrospective cohort study , univariate , cardiology , brier score , surgery , multivariate analysis , statistics , confidence interval , multivariate statistics , mathematics
Background Predicting which patients are unlikely to benefit from continuous flow left ventricular assist device (LVAD) treatment is crucial for the identification of appropriate patients. Previously developed scoring systems are limited to past eras of device or restricted to specific devices. Our objective was to create a risk model for patients treated with continuous flow LVAD based on the preimplant variables. Methods and Results We performed a retrospective analysis of all patients implanted with a continuous flow LVAD between 2006 and 2014 at the University of Pennsylvania and included a total of 210 patients (male 78%; mean age, 56±15; mean follow‐up, 465±486 days). From all plausible preoperative covariates, we performed univariate Cox regression analysis for covariates affecting the odds of 1‐year survival following implantation ( P <0.2). These variables were included in a multivariable model and dropped if significance rose above P =0.2. From this base model, we performed step‐wise forward and backward selection for other covariates that improved power by minimizing Akaike Information Criteria while maximizing the Harrell Concordance Index. We then used Kaplan–Meier curves, the log‐rank test, and Cox proportional hazard models to assess internal validity of the scoring system and its ability to stratify survival. A final optimized model was identified based on clinical and echocardiographic parameters preceding LVAD implantation. One‐year mortality was significantly higher in patients with higher risk scores (hazard ratio, 1.38; P =0.004). This hazard ratio represents the multiplied risk of death for every increase of 1 point in the risk score. The risk score was validated in a separate patient cohort of 260 patients at Columbia University, which confirmed the prognostic utility of this risk score ( P =0.0237). Conclusion We present a novel risk score and its validation for prediction of long‐term survival in patients with current types of continuous flow LVAD support.