Bontempi Luca, Vassanelli Francesca, Cerini Manuel, Inama Lorenza, Salghetti Francesca, Giacopelli Daniele, Gargaro Alessio, Raweh Abdallah, Curnis Antonio
Division of Cardiology, Spedali Civili Hospital, Brescia, Italy.
Clinical research, Biotronik Italia, Milano, Italy.
J Cardiovasc Electrophysiol. 2017 Jul;28(7):811-818. doi: 10.1111/jce.13223. Epub 2017 May 9.
A lead extraction difficulty (LED) score was proposed to predict the difficult transvenous lead extraction (TLE) procedures, defined by means of the fluoroscopy time. The aim of this study was to validate the estimation model based on the LED index above 10 on an independent data set of TLE cases.
Consecutive patients undergoing TLE between January 2014 and January 2016 were included in this analysis. The fluoroscopy time related to the leads removal was dichotomized as above or below its 90th percentile (PCTL).
In total, 446 permanent leads were removed during 233 TLE procedures. Complete procedural success was achieved in 232 (99.1%) patients. The LED index resulted >10 in 83(35.6%) procedures. Among these cases, 20 had fluoroscopy time above the 90th PCTL (23.3 minutes) and were classified as true positive. Over the 150 procedures with LED score <10, 147 were classified as true negative, and only 3 resulted false negative. The sensitivity, the specificity, and the negative predictive value of the LED index in predicting complex cases resulted 86.9 (confidence interval [CI] 66.4-97.2)%, 70.0 (CI 63.3-76.1)%, and 98.0 (CI 94.3-99.6)%, respectively. The multivariate logistic regression analysis confirmed a 12% increased risk of high fluoroscopy for each additional point of the LED score (OR 1.12, CI 1.05-1.21, P = 0.001).
The validation of the estimation model based on the LED index <10 confirmed its high efficacy in predicting simple TLE procedures.
提出了一个导线拔除难度（LED）评分来预测经静脉导线拔除（TLE）困难程度，该评分通过透视时间来定义。本研究的目的是在一个独立的TLE病例数据集上验证基于LED指数大于10的估计模型。
纳入2014年1月至2016年1月期间连续接受TLE的患者进行分析。与导线拔除相关的透视时间被分为高于或低于其第90百分位数（PCTL）。
在233例TLE手术中，共拔除了446根永久性导线。232例（99.1%）患者手术完全成功。83例（35.6%）手术的LED指数大于10。在这些病例中，20例的透视时间高于第90百分位数（23.3分钟），被分类为真阳性。在150例LED评分小于10的手术中，147例被分类为真阴性，只有3例为假阴性。LED指数预测复杂病例的敏感性、特异性和阴性预测值分别为86.9（置信区间[CI]66.4 - 97.2）%、70.0（CI 63.3 - 76.1）%和98.0（CI 94.3 - 99.6）%。多因素逻辑回归分析证实，LED评分每增加1分，透视时间延长的风险增加12%（比值比1.12，CI 1.05 - 1.21，P = 0.001）。
基于LED指数小于10的估计模型的验证证实了其在预测简单TLE手术方面的高效性。
