Oszczygieł Ewa, Kutarski Andrzej, Oszczygieł Andrzej, Mańkowska-Załuska Beata, Chudzik Michał, Wranicz Jerzy Krzysztof, Cygankiewicz Iwona
Department of Cardiology and Heart Rhythm Disorders, Medical University, Łódź, Poland.
Departmenf of Cardiology, Medical University, Lublin, Poland.
Pacing Clin Electrophysiol. 2017 Aug;40(8):918-923. doi: 10.1111/pace.13127. Epub 2017 Jul 21.
The main aim of this study was to assess 1-year mortality and its predictors in a cohort of patients who underwent transvenous lead extraction (TLE) procedure.
Retrospective analysis of clinical characteristics and 1-year follow-up of patients referred for a TLE procedure in a single, high-volume center between June 2006 and October 2014 was performed.
The studied population included 130 patients (82 males; mean age 64 ± 15 years) implanted with pacemakers (74%), implantable cardioverter defibrillators (15%), or cardiac resynchronization therapy defibrillator (11%). Indications for the extraction included infective endocarditis (40.5%), pocket infection (18.5%), and lead fault or failure (41%). Total radiological success rate was 90% while clinical success rate was 93.5%. The cumulative 1-year mortality was 28%. Mortality was higher in a group of older patients (94.4% vs 68%, P = 0.001) and those with chronic kidney disease (33.3% vs 4.3 %, P = 0.0002) as well as in patients after removal of high voltage lead (88.9% vs 26.3%, P = 0.01). Higher mortality was also related to infection as an indication for TLE (37.2% vs 13.5%, P = 0.002). Following these findings a new risk score model named IKAR (I = infective indications; K = kidney dysfunction; A = age ≥ 56; R = removal of high voltage lead) was constructed. Patients with IKAR score ≥3 points were characterized by 79% mortality as compared to 16% in those with a score 1-2 points.
One-year mortality of patients undergoing TLE procedure can be predicted by using IKAR risk score.
本研究的主要目的是评估接受经静脉导线拔除术（TLE）的患者队列的1年死亡率及其预测因素。
对2006年6月至2014年10月期间在一个高容量单一中心接受TLE手术的患者的临床特征进行回顾性分析，并进行1年随访。
研究人群包括130例患者（82例男性；平均年龄64±15岁），植入起搏器的患者占74%，植入式心脏复律除颤器的患者占15%，心脏再同步化治疗除颤器的患者占11%。拔除导线的指征包括感染性心内膜炎（40.5%）、囊袋感染（18.5%）和导线故障或失效（41%）。总放射学成功率为90%，临床成功率为93.5%。1年累计死亡率为28%。老年患者组（94.4%对68%，P=0.001）、患有慢性肾病的患者（33.3%对4.3%，P=0.0002）以及拔除高压导线后的患者（88.9%对26.3%，P=0.01）的死亡率更高。较高的死亡率也与作为TLE指征的感染有关（37.2%对13.5%，P=0.002）。基于这些发现，构建了一个名为IKAR的新风险评分模型（I=感染指征；K=肾功能不全；A=年龄≥56岁；R=拔除高压导线）。IKAR评分≥3分的患者死亡率为79%，而评分1-2分的患者死亡率为16%。
使用IKAR风险评分可以预测接受TLE手术患者的1年死亡率。
