在超过 5000 例慢性血管内起搏器和除颤器导联拔除的经验中，预测患者不良结局的临床因素。

Clinical predictors of adverse patient outcomes in an experience of more than 5000 chronic endovascular pacemaker and defibrillator lead extractions.

机构信息

Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.

Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio.

出版信息

Heart Rhythm. 2014 May;11(5):799-805. doi: 10.1016/j.hrthm.2014.01.016. Epub 2014 Jan 17.

DOI:10.1016/j.hrthm.2014.01.016

PMID:24444444

Abstract

BACKGROUND

It is difficult to predict adverse patient outcomes associated with transvenous lead extraction (TLE) procedures.

OBJECTIVE

The purpose of this study was to examine the safety and efficacy of chronic endovascular pacemaker and implantable cardioverter-defibrillator (ICD) lead extraction and risk factors associated with adverse patient outcomes.

METHODS

Consecutive patients undergoing TLE at the Cleveland Clinic between August 1996 and August 2011 were included in the analysis. Univariate and multivariable logistic regression analyses were performed to evaluate for associations with outcomes. Continuous data are given as median (25th, 75th percentile). Categorical data are given as number (percentage).

RESULTS

In total, 5521 leads (4137 [74.9%] pacemaker, 1384 [25.1%] ICD) were extracted during 2999 TLE procedures (patient age 67.2 [55.2, 76.2] years, 30.2% female). Lead implant duration was 4.7 (2.4, 8.3) years, and 2.0 (1.0, 2.0) leads were extracted per procedure. Powered sheaths were used in 74.9% of procedures. Overall, there was 95.1% complete procedural success, 98.9% clinical success, and 1.1% failure, with 3.6% minor complications and 1.8% major complications. All-cause mortality within 30 days of TLE was 2.2%. Multivariable predictors of major complications included cerebrovascular disease, ejection fraction ≤15%, lower platelet count, international normalized ratio ≥1.2, mechanical sheaths, and powered sheaths. Multivariable predictors of all-cause mortality within 30 days of TLE included body mass index <25 kg/m(2), end-stage renal disease, higher New York Heart Association functional class, lower hemoglobin, higher international normalized ratio, lead extraction for infection, and extraction of a dual-coil ICD lead.

CONCLUSION

TLE in this single-center experience was highly successful. Risk factors associated with adverse patient outcomes were identified.

摘要

背景

预测经静脉心脏起搏器和植入式心律转复除颤器（ICD）导线拔除术（TLE）相关不良患者结局较为困难。

目的

本研究旨在评估慢性血管内起搏器和 ICD 导线拔除术的安全性和有效性，并探讨与不良患者结局相关的危险因素。

方法

连续纳入 1996 年 8 月至 2011 年 8 月在克利夫兰诊所行 TLE 的患者。采用单因素和多因素逻辑回归分析评估与结局相关的因素。连续变量以中位数（25 分位数，75 分位数）表示。分类变量以例数（百分比）表示。

结果

共对 5521 根导线（4137 根[74.9%]为起搏器导线，1384 根[25.1%]为 ICD 导线）进行了 2999 次 TLE 操作（患者年龄 67.2[55.2，76.2]岁，30.2%为女性）。导线植入时间为 4.7（2.4，8.3）年，每次手术平均拔除 2.0（1.0，2.0）根导线。74.9%的手术中使用了可旋切鞘。总体而言，手术完全成功率为 95.1%，临床成功率为 98.9%，失败率为 1.1%，轻微并发症发生率为 3.6%，严重并发症发生率为 1.8%。TLE 术后 30 天内全因死亡率为 2.2%。多因素分析显示，主要并发症的预测因素包括脑血管疾病、射血分数≤15%、血小板计数较低、国际标准化比值（INR）≥1.2、机械鞘管和旋切鞘管。TLE 术后 30 天内全因死亡的预测因素包括体重指数（BMI）<25kg/m2、终末期肾病、纽约心脏病协会（NYHA）心功能分级较高、血红蛋白较低、INR 较高、因感染而拔除导线、拔除双线圈 ICD 导线。