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Outcomes in Patients with Ischemic Cardiomyopathy (ICM) Post-Heart Transplant (HT) by Era

Authors
Journal
The Journal of Heart and Lung Transplantation
1053-2498
Publisher
Elsevier
Volume
32
Issue
4
Identifiers
DOI: 10.1016/j.healun.2013.01.233
Disciplines
  • Medicine

Abstract

Purpose Pre-HT diagnosis of ICM has become less prevalent over time in large part due to advances in revascularization leading to more advanced presentations at time of HT. We sought to study survival by era in this population. Methods and Materials 39759 HT recipients (exclusions included age<18 & multiorgan) were identified from UNOS (1987-2011) & stratified by etiology & era. Survival was censored at 12y. Multivariate Cox proportional hazard regression analysis was adjusted for age, sex, DM, race, ischemic time, dialysis, life support, wait time & HLA mismatch. Results 19087 (48%) pts were ischemic (Era 1-1987-94: 6107 (52%); Era 2-1995-99: 4703 (52%); Era 3-2000-2004: 3696 (47%); Era 4-2005-11: 4581 (41%). Age and diabetes increased by era (p < 0.001). Prior cardiac surgery increased by era (Era 1-4: 0.1%, 0.5%, 10.0%, 55%; p < 0.001). VAD use increased by era (Era 1-4: 3%, 13%, 24%, 30%; p < 0.001). Creatinine progressively decreased by era (p<0.001). Pts listed Status 1 increased by era (Era 1-4: 53%, 69%, 72%, 87%; p <0.001). Survival is shown in Figure 1 by ICM (A); era & ICM (B-D). Unadjusted HR (CI) for all-cause mortality (as compared to era 1) was era 2 [0.84 (0.80-0.89)]; era 3 [0.75 (0.71-0.79)] & era 4 [0.67 (0.62-0.72)]. After adjustment, all-cause mortality (as compared to era 1) was era 2 [0.71 (0.67-0.76)]; era 3 [0.61 (0.56-0.65)] & era 4 [0.53 (0.48-0.58)]. Conclusions Post HT survival improves by era in ICM pts despite increasing pt complexity (i.e. increased Status 1 pts, prior cardiac surgery, older age, diabetes, and increased VAD use).

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