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- W2180668702 abstract "Pump thrombosis (PT) of a left ventricular assist device (LVAD) is a potentially devastating complication of long-term support. Multiple publications recently reported an increase in pump thrombosis among CF-LVADs, especially within the first 6 months of implant. We sought to create a multivariate model to predict future PT. We retrospectively identified 442 consecutive patients who underwent CF-LVAD implantation between 1/2005 and 9/2014. A univariate Cox proportional hazards model using competing risks methodology was built upon 30 variables known or thought to be associated with PT. Based on univariate findings, several variables of interest were found: age, BMI, use of erythropoietin stimulating agents (ESAs), platelet count, smoking history, and prior temporary mechanical support. These variables were used to develop a multivariable Cox model to predict PT. A step-down variable selection technique with Akaike’s information criteria used to establish a stopping point was conducted to develop a parsimonious, multivariable Cox model. Age and gender were forced into the model as previously reported predictors of PT. The model-based probabilities of PT at 6 months were determined for all patients within the data cohort. The c-statistic was generated to assess the prediction model’s ability to discriminate events and non-events. A calibration plot was used to evaluate the accuracy of the model’s results in reflecting actual event rates. During a mean follow up of 17.8 ± 13.8 months, 69 (15.5%) patients had PT and 230 (51.6%) died or had a heart transplant prior to thrombosis. The majority of patients were male (81%) with a mean age of 56 and a median INTERMACS profile of 2. The univariate model showed age, BMI, history of smoking, and use of ESAs to be associated with PT. The final multivariable model included age (HR 0.981, 95% CI 0.962-1.00), male sex (HR 1.09, 95% CI 0.589-2.016), BMI (HR 1.054, 95% CI 1.013-1.097), use of ESAs (HR 1.581, 95% CI 0.966- 2.588), and history of smoking (HR 1.823, 95% CI 1.095-3.036), with a C-statistic = 0.68 (95% CI 0.59-0.77, p < 0.001). A plot of the mean predicted probabilities and estimated 6-month event rates by quintile is shown below (Figure 1). Predictors of pump thrombosis identified were age, sex, BMI, use of ESAs, and smoking. Once validated in an external cohort, this risk model may provide the framework to create patient specific anticoagulation strategies." @default.
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- W2180668702 date "2015-08-01" @default.
- W2180668702 modified "2023-10-17" @default.
- W2180668702 title "Preoperative Risk Model for Prediction Pump Thrombosis in LVADs" @default.
- W2180668702 doi "https://doi.org/10.1016/j.cardfail.2015.06.284" @default.
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