From Duke University Medical Center, Durham, NC (S.D.P., R.K.L., E.P.Z., S.M.A.-K., D.D.H., J.P.P.); Duke Clinical Research Institute, Durham, NC (S.D.P., X.M., M.G., E.P.Z., S.M.A.-K., J.P.P.); Brigham and Women's Hospital, Boston, MA (L.M.E.); and University of Miami, FL (R.G.C.).
Circulation. 2017 Oct 10;136(15):1387-1395. doi: 10.1161/CIRCULATIONAHA.117.027636. Epub 2017 Aug 22.
Lead management is an increasingly important aspect of care in patients with cardiac implantable electronic devices; however, relatively little is known about long-term outcomes after capping and abandoning leads.
Using the 5% Medicare sample, we identified patients with de novo cardiac implantable electronic device implantations between January 1, 2000, and December 31, 2013, and with a subsequent lead addition or extraction ≥12 months after the de novo implantation. Patients who underwent extraction for infection were excluded. Using multivariable Cox proportional hazards models, we compared cumulative incidence of all-cause mortality, device-related infection, device revision, and lead extraction at 1 and 5 years for the extraction versus the cap and abandon group.
Among 6859 patients, 1113 (16.2%) underwent extraction, whereas 5746 (83.8%) underwent capping and abandonment. Extraction patients tended to be younger (median, 78 versus 79 years; <0.0001), were less likely to be male (65% versus 68%; =0.05), and had shorter lead dwell time (median, 3.0 versus 4.0 years; <0.0001) and fewer comorbidities. Over a median follow-up of 2.4 years (25th, 75th percentiles, 1.0, 4.3 years), the overall 1-year and 5-year cumulative incidence of mortality was 13.5% (95% confidence interval [CI], 12.7-14.4) and 54.3% (95% CI, 52.8-55.8), respectively. Extraction was associated with a lower risk of device infection at 5 years relative to capping (adjusted hazard ratio, 0.78; 95% CI, 0.62-0.97; =0.027). There was no association between extraction and mortality, lead revision, or lead extraction at 5 years.
Elective lead extraction for noninfectious indications had similar long-term survival to that for capping and abandoning leads in a Medicare population. However, extraction was associated with lower risk of device infections at 5 years.
心脏植入式电子设备患者的铅管理是护理中日益重要的方面；然而，对于铅帽和废弃后导线的长期结果相对知之甚少。
使用 5%的医疗保险样本，我们确定了 2000 年 1 月 1 日至 2013 年 12 月 31 日期间初次植入心脏植入式电子设备的患者，并且在初次植入后 12 个月以上进行了随后的导线添加或提取。排除因感染而行提取的患者。使用多变量 Cox 比例风险模型，我们比较了提取组与帽和放弃组在 1 年和 5 年时全因死亡率、器械相关感染、器械修订和导线提取的累积发生率。
在 6859 例患者中，1113 例（16.2%）进行了提取，5746 例（83.8%）进行了铅帽和废弃。提取组患者年龄较小（中位数，78 岁比 79 岁；<0.0001），男性较少（65%比 68%；=0.05），导线留置时间较短（中位数，3.0 年比 4.0 年；<0.0001），合并症较少。在中位随访 2.4 年（25%，75%分位数，1.0，4.3 年）中，1 年和 5 年的总体死亡率累积发生率分别为 13.5%（95%置信区间[CI]，12.7-14.4）和 54.3%（95% CI，52.8-55.8）。与铅帽相比，5 年时提取与器械感染风险较低相关（校正风险比，0.78；95% CI，0.62-0.97；=0.027）。提取与 5 年时的死亡率、导线修订或导线提取之间没有关联。
在医疗保险人群中，对于非感染性适应证的选择性导线提取与铅帽和废弃导线具有相似的长期生存率。然而，提取与 5 年时器械感染的风险较低相关。
