0384: Are prognostic scores useful for risk stratification in cardiac transplantation? Insight from a French cardiac surgery center experience

Abstract

The Seattle Heart Failure Model (SHFM), the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) and the Index for Mortality Prediction After Cardiac Transplantation (IMPACT) score are newly used in heart transplantation for graft allocation. We aimed if these scores could be useful in risk stratification for cardiac transplantation in our center. The SHFM, the INTERMACS model and the IMPACT score were retrospectively calculated for 182 heart transplantation candidates and 152 non-VAD patients who underwent urgent and non-urgent heart transplantation between January 2004 and April 2013 in our center. Results were compared with actual mortality at 1, 2 and 5 years. The performance of these score in predicting hospital mortality was evaluated with ROC curve. Predicted mortality at 1, 2 and 5 years with the SHFM score was significantly higher (p<0.001) in patients who required urgent transplantation. This score was not efficient for predicting waiting list mortality (AUC= 0,70). A trend toward higher post-transplant mortality at 1, 2 and 5 years was observed in the 1 to 3 INTERMACS class. All patients with INTERMACS I profile dead after heart transplantation. The IMPACT score was not efficient in predicting post transplantation mortality in our population (AUC = 0,56). The SHFM should be used to discriminate patients on waiting list and discuss the degree of required priority. The INTERMACS classification appears to be promising tools for heart recipient selection. IMPACT score seems not adapted to in our population.