The Society of Thoracic Surgeons National Intermacs Database Risk Model for Durable Left Ventricular Assist Device Implantation

IF 3.9 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Thoracic Surgery Pub Date : 2025-04-01 Epub Date: 2025-01-24 DOI:10.1016/j.athoracsur.2024.11.039

Francis D. Pagani MD, PhD , Brandon Singletary PhD , Ryan Cantor PhD , J. Hunter Mehaffey MD , Aditi Nayak MD, MS , Jeffrey Teuteberg MD , Palak Shah MD , Jennifer Cowger MD, MS , J. David Vega MD , Daniel Goldstein MD , Paul A. Kurlansky MD , Josef Stehlik MD , Jeffrey Jacobs MD , David Shahian MD , Robert Habib PhD , Todd F. Dardas MD, MS , James K. Kirklin MD

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Abstract

Background

Statistical risk models for durable left ventricular assist device (LVAD) implantation inform candidate selection, quality improvement, and evaluation of provider performance. This study developed a 90-day mortality risk model using The Society of Thoracic Surgeons National Intermacs Database (STS Intermacs).

Methods

STS Intermacs was queried for primary durable LVAD implants from January 2019 to September 2023. Multivariable logistic regression was used to derive a model based on preimplant risk factors by using derivation (2019-2021 implants) and validation (2022-2023 implants) cohorts. Model performance (derivation and validation cohorts) was assessed using C-statistics, Brier scores, and calibration plots. A refined model (all patients) was generated to calculate observed-to-expected (O/E; 95% CI) ratios for each center.

Results

The study population consisted of 11,342 patients from 2019 to 2023 who were sequentially divided in time into derivation (n = 6775) and validation (n = 4567) cohorts. Ninety-day mortality was 8.0% (9.2% in the derivation cohort vs 7.4% in the validation cohort; P = .001). Logistic regression applied to derivation and validation cohorts produced similar discrimination (area under the curve [AUC], 0.714 [95% CI, 0.69-0.74]; and AUC, 0.707; [95% CI, 0.67-0.72], respectively) and calibration (Brier score, .08 vs .07), with overestimation of risk among patients with a predicted risk >0.4. The O/E analysis identified 22 (12.5%) centers with worse than expected mortality with a 95% CI >1.0 and 14 centers (8.0%) with better than expected mortality with a 95% CI <1.0 (all P < .05).

Conclusions

The STS Intermacs risk model demonstrated satisfactory discrimination and calibration. This tool may be used to inform candidate selection, facilitate quality improvement, and assess provider performance.

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胸外科学会国家Intermacs数据库持久左心室辅助装置植入风险模型。

背景：持久左心室辅助装置（LVAD）植入的统计风险模型为候选人选择、质量改进和评估提供者绩效提供了信息。我们利用胸外科学会国家Intermacs数据库（STS Intermacs）建立了一个90天死亡率风险模型。方法：从2019年1月至2023年9月，对STS Intermacs的初级耐用LVAD植入物进行查询。使用衍生队列（2019-2021种植体）和验证队列（2022-2023种植体），使用多变量逻辑回归来推导基于种植前风险因素的模型。使用c统计、Brier评分和校准图评估模型性能（推导和验证队列）。生成一个精细模型（所有患者）来计算每个中心的观察/期望[O/E， 95%置信区间（CI）]比率。结果：研究人群包括2019-2023年的11,342例患者，按时间顺序分为衍生（n=6,775）和验证（n=4,567）。90天死亡率为8.0%(衍生队列为9.2%，验证队列为7.4%；p = 0.001)。推导和验证队列应用Logistic回归产生了类似的判别（曲线下面积（AUC） 0.714, CI: 0.69-0.74和AUC 0.707, CI: 0.67-0.72）和校准（Brier评分0.08 vs 0.07），预测风险> .4的患者风险高估。O/E分析发现22个中心（12.5%）的死亡率低于预期，CI为1.0；14个中心（8.0%）的死亡率低于预期，CI < 1.0（均p < 0.05）。结论：STS Intermacs风险模型具有良好的鉴别和校正效果。该工具可用于通知候选人的选择，促进质量改进，并评估供应商的表现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Thoracic Surgery 医学-呼吸系统

CiteScore

6.40

自引率

13.00%

发文量

1235

审稿时长

42 days

期刊介绍： The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.