Feldman Alyssa M, Kersten Daniel J, Chung Jessica A, Asheld Wilbur J, Germano Joseph, Islam Shahidul, Cohen Todd J
Winthrop University Hospital, 120 Mineola Boulevard, Suite 500, Mineola, NY 11501. Email:
J Invasive Cardiol. 2015 Dec;27(12):530-4.
The purpose of this study was to investigate the influences of gender and age on defibrillator lead failure and patient mortality.
The specific influences of gender and age on defibrillator lead failure have not previously been investigated.
This study analyzed the differences in gender and age in relation to defibrillator lead failure and mortality of patients in the Pacemaker and Implantable Defibrillator Leads Survival Study ("PAIDLESS"). PAIDLESS includes all patients at Winthrop University Hospital who underwent defibrillator lead implantation between February 1, 1996 and December 31, 2011. Male and female patients were compared within each age decile, beginning at 15 years old, to analyze lead failure and patient mortality. Statistical analyses were performed using Wilcoxon rank-sum test, Fisher's exact test, Kaplan-Meier analysis, and multivariable Cox regression models. P<.05 was considered statistically significant. No correction for multiple comparisons was performed for the subgroup analyses.
A total of 3802 patients (2812 men and 990 women) were included in the analysis. The mean age was 70 ± 13 years (range, 15-94 years). Kaplan-Meier analysis found that between 45 and 54 years of age, leads implanted in women failed significantly faster than in men (P=.03). Multivariable Cox regression models were built to validate this finding, and they confirmed that male gender was an independent protective factor of lead failure in the 45 to 54 years group (for male gender: HR, 0.37; 95% confidence interval, 0.14-0.96; P=.04). Lead survival time for women in this age group was 13.4 years (standard error, 0.6), while leads implanted in men of this age group survived 14.7 years (standard error, 0.3). Although there were significant differences in lead failure, no differences in mortality between the genders were found for any ages or within each decile.
This study is the first to compare defibrillator lead failure and patient mortality in relation to gender and age deciles at a single large implanting center. Within the 45 to 54 years group, leads implanted in women failed faster than in men. Male gender was found to be an independent protective factor in lead survival. This study emphasizes the complex interplay between gender and age with respect to implantable defibrillator lead failure and mortality.
本研究旨在调查性别和年龄对除颤器导线故障及患者死亡率的影响。
此前尚未研究性别和年龄对除颤器导线故障的具体影响。
本研究分析了起搏器和植入式除颤器导线生存研究（“PAIDLESS”）中患者的性别和年龄在除颤器导线故障及死亡率方面的差异。PAIDLESS纳入了1996年2月1日至2011年12月31日期间在温思罗普大学医院接受除颤器导线植入的所有患者。从15岁开始，在每个年龄十分位数内对男性和女性患者进行比较，以分析导线故障和患者死亡率。使用Wilcoxon秩和检验、Fisher精确检验、Kaplan-Meier分析和多变量Cox回归模型进行统计分析。P<0.05被认为具有统计学意义。亚组分析未进行多重比较校正。
共有3802例患者（2812例男性和990例女性）纳入分析。平均年龄为70±13岁（范围15 - 94岁）。Kaplan-Meier分析发现，在45至54岁之间，女性植入的导线比男性失效明显更快（P = 0.03）。构建多变量Cox回归模型以验证这一发现，结果证实男性性别是45至54岁组导线故障的独立保护因素（男性性别：HR，0.37；95%置信区间，0.14 - 0.96；P = 0.04）。该年龄组女性的导线生存时间为13.4年（标准误，0.6），而该年龄组男性植入的导线生存14.7年（标准误，0.3）。尽管导线故障存在显著差异，但在任何年龄或每个十分位数内，性别间的死亡率均未发现差异。
本研究首次在单一大型植入中心比较了除颤器导线故障及患者死亡率与性别和年龄十分位数的关系。在45至54岁组中，女性植入的导线比男性失效更快。发现男性性别是导线生存的独立保护因素。本研究强调了性别和年龄在植入式除颤器导线故障及死亡率方面的复杂相互作用。
