Novel Scoring System to Risk Stratify Patients Receiving Durable Left Ventricular Assist Device From J-MACS Registry Data

• Published in: Circulation Journal Vol. 87; no. 8; pp. 1103 - 1111
• Main Authors: Imamura, Teruhiko, Kinugawa, Koichiro, Nishimura, Takashi, Toda, Koichi, Saiki, Yoshikatsu, Niinami, Hiroshi, Nunoda, Shinichi, Matsumiya, Goro, Nishimura, Motonobu, Arai, Hirokuni, Yanase, Masanobu, Fukushima, Norihide, Nakatani, Takeshi, Shiose, Akira, Shibasaki, Ikuko, Sakata, Yasushi, Ono, Minoru, Investigators, J-MACS
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 25-07-2023
• Subjects: Heart Failure; Heart Transplantation; Heart-Assist Devices - adverse effects; Hemodynamics; Humans; Mechanical circulatory support; Mortality; Retrospective Studies; Risk Factors; Routinely Collected Health Data; Treatment Outcome; Heart failure; Hemodynamics; Mechanical circulatory support; Mortality
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-23-0264

Background: Recently, destination therapy (DT) was approved in Japan, and patients ineligible for heart transplantation may now receive durable left ventricular assist devices (LVADs). Several conventional risk scores are available, but a risk score that is best to select optimal candidates for DT in the Japanese population remains unestablished.Methods and Results: A total of 1,287 patients who underwent durable LVAD implantation and were listed for the Japanese registry for Mechanically Assisted Circulatory Support (J-MACS) were eligible for inclusion. Finally, 494 patients were assigned to the derivation cohort and 487 patients were assigned to the validation cohort. According to the time-to-event analyses, J-MACS risk scores were newly constructed to predict 3-year mortality rate, consisting of age, history of cardiac surgery, serum creatinine level, and central venous pressure to pulmonary artery wedge pressure ratio >0.71. The J-MACS risk score had the highest predictability of 3-year death compared with other conventional scores in the validation cohort, including HeartMate II risk score and HeartMate 3 risk score.Conclusions: We constructed the J-MACS risk score to estimate 3-year mortality rate after durable LVAD implantation using large-scale multicenter Japanese data. The clinical utility of this scoring to guide the indication of DT should be validated in the next study.