Utility of the INTERMACS profile at the time of assessment for heart transplant

Abstract

The Interagency Registry of Mechanically Assisted Circulatory Support (INTERMACS) profiles are associated with mortality in heart failure patients undergoing ventricular assist device (VAD) implantation and heart transplantation (HTx). We assessed the prognostic value of the INTERMACS profile at the time of assessment for HTx or durable VAD implantation as bridge to candidacy (BTC). A total of 503 consecutive patients considered for HTx or VAD between 2006 and 2016 were included. The associations between INTERMACS profile and (a) waitlist mortality or delisting, (b) probability of HTx, and (c) overall mortality or delisting were evaluated using multivariable analysis. Median follow‐up time was 2.9 years (IQR: 0.9‐5.5) during which 184 received VAD, 347 received HTx, and 73 died (27 waitlist, 46 post‐transplant). INTERMACS I‐II profile was associated with higher waitlist mortality or delisting (HR: 3.83, 95% CI: 1.22‐12.03), and this risk was reversed by VAD implantation (HR: 0.12, 95% CI: 0.03‐0.50). INTERMACS III‐IV profile was associated with a higher probability of HTx (HR: 1.82, 95% CI: 1.37‐2.40). INTERMACS profile was not associated with the composite outcome of overall mortality or delisting. These results emphasize the prognostic utility of INTERMACS at time of decision for advanced therapies and its potential value in selecting patients for different interventions.

Patient selection for heart transplant: balancing risk

“…Several clinical risk prediction scores have been developed to risk stratify patients with heart failure and evaluate the potential benefit of advanced therapies. The most well recognized are the Seattle Heart Failure Model (SHFM), the Heart Failure Survival Score (HFSS), and the Interagency Registry for Mechanically Assisted Circulatory Support (INTER-MACS) [4,30]. The application of machine learning to clinical registry to predict posttransplant outcomes is an active area of research [31].…”

“…The 2021 European Society of Cardiology Guidelines propose utilizing the INTERMACS profiles to guide early risk stratification for temporary mechanical support and consideration for transplantation [14 ▪▪ ,33]. However, Friesen et al [30] and found no statistically significant association between specific INTERMACS profiles at presentation and composite outcome of mortality or de-listing.…”

Red blood cell distribution width to predict mortality in heart transplant recipients: a systematic review

“…This surgical procedure can prolong survival approximately 11 years in end-stage heart failure adult patients [4]; in addition, close to 85% of recipients survive the first year post-HT [5]. There are several factors associated with a poor prognosis in HT recipients, such as mechanical circulatory support [4], history of congenital heart disease, restrictive cardiomyopathy, re-transplantation [4], pre-transplant serum creatinine higher than 2.0 mg/dL [4], pre-transplant total bilirubin higher than 2.0 mg/dL [4], recipient age higher than 55 years old [4], pre-operative clinical instability, defined as Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile I (cardiogenic shock); or profile II (progressive clinical decline despite treatment with inotropes) [6,7]; as well as donor factors, such as advanced donor age and prolonged donor heart ischemia [4]. Even considering these factors, the rate of mortality in HT recipients is high, therefore, determining prognostic markers in these patients will always be helpful in making evidence-based decisions.…”