Utilidad del IMPACT score como predictor de riesgo tras el trasplante cardiaco en la población española

Abstract

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...