Safety of Transvenous Lead Removal in Patients ≥70 Years of Age in the United States from 2005 to 2012.

Autor: Guo X; Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, US. Electronic address: guoxiaofan1986@hotmail.com., Hayward RM; Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California, US., Vittinghoff E; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, US., Liu Y; Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California, US., Lee SY; Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California, US., Pletcher MJ; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, US., Lee BK; Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California, US.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2018 Sep 01; Vol. 122 (5), pp. 799-805. Date of Electronic Publication: 2018 Jun 02.
DOI: 10.1016/j.amjcard.2018.05.014
Abstrakt: Cardiac devices are increasingly an element of treatment for the elderly, leading to more frequent transvenous lead removal (TLR) procedures in this population. Data on TLR in very elderly patients, especially nonagenarians, is scarce. We used Healthcare Cost and Utilization Project Nationwide Inpatient Sample to identify a total of 36,099 patients ≥70 years who underwent TLR from 2005 to 2012, with outcomes including in-hospital mortality and complications. The in-hospital mortality rate was significantly higher in nonagenarians without device infection (0.9% in age 70 to 79 vs 0.7% in age 80 to 89 vs 2.6% in age ≥90, p = 0.012), but overall complication rates were not different in age groups regardless of infection status and co-morbidity index (all p >0.05). Among patients with device infection, octogenarians, and nonagenarians were not associated with increased risk of in-hospital mortality relative to septuagenarians after controlling for all other confounders. However, in patients without device infection, logistic regression showed significantly higher mortality in patients age ≥90 years (odd ratio 4.22, 95% confidence interval 1.66 to 10.75, p = 0.003), but not in patients age 80 to 89 years (odd ratio 1.05, 95% confidence interval 0.48 to 2.30, p = 0.907), compared with patients age 70 to 79 years. In conclusion, in nonagenarians with infection, mortality is driven more by the patient's other conditions than by age. For patients without infection, however, nonagenarians experienced higher mortality than younger patients.
(Copyright © 2018 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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