Development of a European Risk Score for Left Ventricular Assist Device Implantation—The EUROMACS-LVAD Score

Objectives: Most data on risk stratification in patients selected for left ventricular assist device (LVAD) implantation stems from U.S.-based studies and is therefore not generalizable to a European population. The aim of this project was to develop a European score for risk stratification in patients selected for LVAD implantation.

Methods: From the EUROMACS database, patients implanted with a rotary LVAD and available follow-up information were selected. In these patients, multivariable Cox’s regression analysis with backward selection was used to identify predictors of 2-year all-cause mortality. Based on the final model, and after internal validation via bootstrapping with 200 repetitions, score points were assigned to each predictor based on its respective beta coefficient. To test the applicability of the risk score, patients were divided into three risk categories. The Kaplan–Meier method was used to evaluate survival probabilities associated with each risk group.

Result: A total of 1872 patients were included into the analysis (mean age, 52 [± 12] years, 15.7% females). The following variables were identified as predictors of 2-year all-cause mortality and included into the risk score: sex, age, left ventricular end-diastolic diameter, mean arterial pressure, mitral regurgitation, tricuspid regurgitation, aortic regurgitation, obesity, concomitant cardiac surgery, use of inotropes, use of vasopressors, ascites, prior cardiac arrest, carotid artery disease, creatinine, GOT, anemia, and INTERMACS class. Two-year survival probability in the low risk group was 0.70 (95% confidence interval [CI]: 0.66–0.75), 0.61 in the intermediate risk group (95% CI: 0.56–0.66) and 0.38 in the high-risk group (95% CI: 0.34–0.43). The difference in survival probability across the three groups was statistically significant (p < 0.01).

Conclusion: This study provides a novel score for risk stratification in European patients selected for LVAD implantation.

No conflict of interest has been declared by the author(s).