Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
Eur Heart J. 2017 Jul 14;38(27):2122-2128. doi: 10.1093/eurheartj/ehx100.
Cardiac resynchronization therapy (CRT) device implantation has been shown to reduce morbidity and mortality in selected patients with heart failure. We sought to investigate the utilization and in-hospital complications of cardiac resynchronization therapy defibrillator (CRT-D) and pacemaker (CRT-P) implantations in the United States from 2003 to 2013.
Patients receiving CRT-D or CRT-P were identified in the National Inpatient Sample database (NIS), using the International Classification of Diseases-Ninth Revision-Clinical Modification procedure codes. Annual implantation rates, patient demographics, co-morbidities, in-hospital complications, and length of stay were analysed. From 2003 to 2013, an estimated total of 439 010 (95% CI: 406 723-471 296) inpatient CRT implantations were performed in the U.S. The median age of patients was 72 and 71% were male. Overall, 6.1% had at least one complication. During the study period, comorbidity index and overall complication rate increased (P = 0.002 and P = 0.01, respectively). Mortality and length of stay showed no significant trend. Predictors of complications included: age 65 and older, female sex (OR: 1.19; 95% CI: 1.12-1.27), Deyo-Charlson Comorbidity Index, and elective admission (OR: 0.61; 95% CI: 0.57-0.66).
From 2003 to 2013, the severity of comorbid conditions increased and a rising trend was observed in the rate of periprocedural complications among patients undergoing CRT in the United States. In-hospital mortality and length of stay showed no uniform trend.
心脏再同步治疗（CRT）设备的植入已被证明可降低心力衰竭患者的发病率和死亡率。我们旨在调查 2003 年至 2013 年期间美国心脏再同步除颤器（CRT-D）和心脏再同步起搏器（CRT-P）植入的使用情况和院内并发症。
在国家住院患者样本数据库（NIS）中，使用国际疾病分类第 9 修订版临床修正程序代码识别接受 CRT-D 或 CRT-P 植入的患者。分析了每年的植入率、患者人口统计学特征、合并症、院内并发症和住院时间。2003 年至 2013 年，美国共进行了估计总数为 439010 例（95%置信区间：406723-471296）的 CRT 住院植入术。患者的中位年龄为 72 岁，71%为男性。总体而言，6.1%的患者至少发生了一种并发症。在研究期间，合并症指数和总体并发症发生率均有所增加（P=0.002 和 P=0.01）。死亡率和住院时间没有明显趋势。并发症的预测因素包括：年龄 65 岁及以上、女性（OR：1.19；95%置信区间：1.12-1.27）、Deyo-Charlson 合并症指数和择期入院（OR：0.61；95%置信区间：0.57-0.66）。
2003 年至 2013 年期间，美国接受 CRT 治疗的患者的合并症严重程度增加，围手术期并发症发生率呈上升趋势。院内死亡率和住院时间没有呈现出一致的趋势。
