Transvenous lead extraction: The influence of age on patient outcomes in the PROMET study cohort.

Autor: Akhtar Z; Cardiology, St. George's University Hospitals, London, UK., Elbatran AI; Cardiology, St. George's University Hospitals, London, UK.; Department of Cardiology, Ain Shams University, Cairo, Egypt., Starck CT; German Heart Centre, Department of Cardiothoracic & Vascular Surgery, Berlin, Germany.; German Centre of Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.; Steinbeis University Berlin, Institute (STI) of Cardiovascular Perfusion, Berlin, Germany., Gonzalez E; University Hospital La Paz, Madrid, Spain., Al-Razzo O; University Hospital La Paz, Madrid, Spain., Mazzone P; San Rafaele Hospital, Milan, Italy., Delnoy PP; Isala Hospital, Zwolle, The Netherlands., Breitenstein A; University Hospital Zurich, Zurich, Switzerland., Steffel J; University Hospital Zurich, Zurich, Switzerland., Eulert-Grehn J; German Heart Centre, Department of Cardiothoracic & Vascular Surgery, Berlin, Germany.; German Centre of Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany., Lanmüller P; German Heart Centre, Department of Cardiothoracic & Vascular Surgery, Berlin, Germany., Melillo F; San Rafaele Hospital, Milan, Italy., Marzi A; Isala Hospital, Zwolle, The Netherlands., Leung LWM; Cardiology, St. George's University Hospitals, London, UK., Domenichini G; Cardiology, St. George's University Hospitals, London, UK., Sohal M; Cardiology, St. George's University Hospitals, London, UK., Gallagher MM; Cardiology, St. George's University Hospitals, London, UK.
Jazyk: angličtina
Zdroj: Pacing and clinical electrophysiology : PACE [Pacing Clin Electrophysiol] 2021 Sep; Vol. 44 (9), pp. 1540-1548. Date of Electronic Publication: 2021 Aug 05.
DOI: 10.1111/pace.14310
Abstrakt: Background: Cardiac implantable electronic device (CIED) therapy contributes to an improvement in morbidity and mortality across all patient demographics. Patient age is a recognized risk factor for unfavorable outcomes in invasive procedures. This is the largest series of non-laser transvenous lead extraction (TLE) evaluating the association between patient age and procedure outcomes.
Methods: Data of 2205 (3849 leads) patients was collected retrospectively from six European TLE centers between January 2005-December 2018 in the PROMET study. Of these, 153 patients with 319 leads were excluded for incomplete data. A comparison of outcomes was performed between the age groups young [< 50 years], young intermediate [50-69 years], older intermediate [70-79 years], and octogenarian [≥80 years].
Results: Infection was most common indication for TLE in the octogenarian cohort, less common in the younger population (60.1% vs. 33.2%, respectively, p < .01). High-voltage leads were extracted most frequently from young patients, less frequently from octogenarians (31.6% vs. 10%, p < .001), while the opposite was evident for pacemaker leads (p < .001). Rotational sheath use was equally prevalent across all patient groups (p = .79). Minor and major complications across all the age groups were statistically similar, as was procedural success; the 30-day mortality was most significant in the octogenarian and least in the young patients (4.9% vs. 0.4%, p = .005). Propensity matching multivariate analysis found systemic infection, lead dwell time, and patient age (p = .013, OR 1.064 [1.013-1.116]) increased risk of 30-day mortality.
Conclusion: TLE is safe and effective across all age groups. 30-day mortality risk is significantly higher in the older patients.
(© 2021 Wiley Periodicals LLC.)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje