Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Sydell and Arnold Miller Heart & Vascular Institute, 9500 Euclid Avenue, Mail Code J3, Cleveland, OH 44195, USA.
Department of Quantitative Health Sciences, Cleveland Clinic, Lerner Research Institute, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Europace. 2017 Aug 1;19(8):1335-1342. doi: 10.1093/europace/euw234.
The incidence, indications, and risk factors for cardiac implantable electronic device (CIED) implantation after cardiac surgery in an era with an aging population are not well described. There are limited data about the survival of these patients compared with a non-device group. We aimed to evaluate the incidence, indications, and risk factors for postoperative CIED implantation. We also assessed survival of these patients compared with a non-device group.
We included all patients without prior CIED implantation who underwent cardiac surgery at our institution from 1996 to 2008. Characteristics associated with CIED implantation were identified by multivariable logistic regression. A propensity model was constructed to compare survival.
A total of 39 546 patients were included in the study of which 1608 patients (4.1%) underwent postoperative CIED implantation. Conduction disease accounted for most devices, but 371 patients underwent CIED implantation for secondary prevention of ventricular arrhythmias. Risk factors associated with implantation included older age, valvular disease, atrial fibrillation, and prior surgery. The propensity-adjusted risk of early death (within 1 year) was significantly less in the device group (hazard ratio [HR] 0.38; 95% confidence interval [CI] 0.22-0.65; P = 0.0004). However, the propensity-adjusted risk of late death was significantly greater in the device group (HR 1.3; 95% CI 1.2-1.5; P = <0.0001).
Despite an aging population, the incidence of CIED implantation after cardiac surgery remains low and varies by the type of operation. Follow-up suggests increased early survival but decreased late survival in patients who undergo CIED implantation compared with a non-device group.
在人口老龄化的时代，心脏手术后植入心脏植入式电子设备（CIED）的发生率、适应证和危险因素尚未得到充分描述。与非设备组相比，这些患者的生存数据有限。我们旨在评估心脏手术后 CIED 植入的发生率、适应证和危险因素。我们还评估了这些患者与非设备组相比的生存情况。
我们纳入了 1996 年至 2008 年期间在我院行心脏手术且无先前 CIED 植入史的所有患者。通过多变量逻辑回归确定与 CIED 植入相关的特征。构建倾向评分模型以比较生存情况。
共纳入 39546 例患者，其中 1608 例（4.1%）患者术后植入了 CIED。传导疾病是最常见的植入原因，但 371 例患者植入 CIED 是为了二级预防室性心律失常。与植入相关的危险因素包括年龄较大、瓣膜疾病、心房颤动和既往手术。设备组早期死亡（1 年内）的风险显著降低（风险比 [HR] 0.38；95%置信区间 [CI] 0.22-0.65；P = 0.0004）。然而，设备组晚期死亡的风险显著增加（HR 1.3；95% CI 1.2-1.5；P <0.0001）。
尽管人口老龄化，但心脏手术后 CIED 植入的发生率仍然较低，且因手术类型而异。随访表明，与非设备组相比，植入 CIED 的患者早期生存率提高，但晚期生存率降低。
