Publication: Utilidad del IMPACT score como predictor de riesgo tras el trasplante cardiaco en la población española
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2021-07-20
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Universidad Complutense de Madrid
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Abstract
La insuficiencia cardiaca es uno de los problemas de salud pública más importantes debido a su morbimortalidad y a los costes sanitarios asociados. Datos procedentes de publicaciones recientes muestran que entorno al 5% de los pacientes con insuficiencia cardiaca se encuentran en estadios avanzados, afectando actualmente entre 250.000 y 500.000 pacientes en Estados Unidos. A pesar de los avances en el tratamiento médico basado en la evidencia en las últimas décadas, la supervivencia a largo plazo de los pacientes con insuficiencia cardiaca avanzada es muy pobre.
El trasplante cardiaco sigue siendo en la actualidad el tratamiento de elección en determinados pacientes con insuficiencia cardiaca avanzada con una supervivencia actual al año del 85% y una mediana de supervivencia de 12 años. Sin embargo, la falta de órganos en los últimos años ha provocado un descenso en el número de trasplantes cardiacos y un aumento del porcentaje de trasplantes urgentes bajo soporte circulatorio mecánico. Este hecho nos obliga a seleccionar de forma adecuada a los receptores de trasplante cardiaco para conseguir los mejores resultados posibles y optimizar con ello los recursos de los que disponemos. En este sentido, se ha desarrollado un score pronóstico que predice la mortalidad a corto y largo plazo en función de la situación clínica del receptor, el IMPACT score (Index for Mortality Prediction After Cardiac Transplantation). Dicho score fue diseñado y validado internamente basándose en una serie de más de 21.000 pacientes procedentes del registro americano United Network for Organ Sharing (UNOS). Recientemente, dicho score ha sido validado externamente en una serie de más de 29.000 pacientes procedentes del registro de la International Society of Heart and Lung Transplantation (ISHLT), demostrando una buena correlación entre la mortalidad observada y esperada (r= 0.87, p<0.001). Sin embargo, de acuerdo con los estándares en la investigación de modelos predictivos, antes de implementar un score de riesgo en la toma de decisiones clínicas, debe evaluarse su capacidad de discriminación y el impacto de su uso en la práctica clínica o en el pronóstico de los pacientes...
Heart failure is one of the most important public health problems due to its associated morbimortality and high health-care cost. Data from recent reports show that 5% of heart failure patients have end-stage disease, currently affecting 250,000 to 500,000 patients in United States. Despite the advances in evidence-based medical treatment in the last decades, long-term survival of advanced heart failure patients is dismal. Heart transplant remains as the gold standard of care for some advanced heart failure patients with current 1-year survival rates of 85% and median survival of 12 years. However, the low organ availability makes imperative to stratify the risk of patients undergoing heart transplantation to improve outcomes. In this regard, a prognostic score that predicts short and long term mortality regarding on recipient clinical situation has been developed, the IMPACT score (Index for Mortality Prediction After Cardiac Transplantation). This score was designed and internally validated based on a series of more than 21,000 patients from the American United Network for Organ Sharing (UNOS) registry. Recently, this score has been externally validated in a series of more than 29,000 patients from the International Society of Heart and Lung Transplantation (ISHLT) registry, demonstrating a good correlation between the observed and expected mortality (r = 0.87, p <0.001). However, according to the standards in prediction model research, before implementing a risk score in daily clinical decision making, their discrimination ability and impact in clinical practice or prognosis should be evaluated...
Heart failure is one of the most important public health problems due to its associated morbimortality and high health-care cost. Data from recent reports show that 5% of heart failure patients have end-stage disease, currently affecting 250,000 to 500,000 patients in United States. Despite the advances in evidence-based medical treatment in the last decades, long-term survival of advanced heart failure patients is dismal. Heart transplant remains as the gold standard of care for some advanced heart failure patients with current 1-year survival rates of 85% and median survival of 12 years. However, the low organ availability makes imperative to stratify the risk of patients undergoing heart transplantation to improve outcomes. In this regard, a prognostic score that predicts short and long term mortality regarding on recipient clinical situation has been developed, the IMPACT score (Index for Mortality Prediction After Cardiac Transplantation). This score was designed and internally validated based on a series of more than 21,000 patients from the American United Network for Organ Sharing (UNOS) registry. Recently, this score has been externally validated in a series of more than 29,000 patients from the International Society of Heart and Lung Transplantation (ISHLT) registry, demonstrating a good correlation between the observed and expected mortality (r = 0.87, p <0.001). However, according to the standards in prediction model research, before implementing a risk score in daily clinical decision making, their discrimination ability and impact in clinical practice or prognosis should be evaluated...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 20/04/2021