Department of Medicine, Rutgers New Jersey Medical School, Rutgers, State University of New Jersey, Newark, New Jersey.
Division of Cardiology, Rutgers New Jersey Medical School, Rutgers, State University of New Jersey, Newark, New Jersey; Department of Medicine, Rutgers New Jersey Medical School, Rutgers, State University of New Jersey, Newark, New Jersey.
JACC Clin Electrophysiol. 2017 Jan;3(1):41-46. doi: 10.1016/j.jacep.2016.05.009. Epub 2016 Aug 3.
The aim of this study was to describe the trends and predictors of cardiac tamponade among permanent pacemaker (PPM) recipients in the United States between 2008 and 2012.
Limited data exist regarding the burden, trend, and predictors of tamponade in patients following PPM implantation.
The National (Nationwide) Inpatient Sample database was used to identify PPM implantations between 2008 and 2012.
Among 922,549 patients who received PPM devices between 2008 and 2012, cardiac tamponade occurred in 2,595 patients (0.28%). Overall, in-hospital cardiac tamponade rates increased by 35% among recipients of PPMs. The incidence rate steadily increased from 0.26% in 2008 to 0.35% in 2012 (p < 0.0001). Although the mean age (p = 0.28) and sex distribution (p = 0.25) did not change over the years, the rate of in-hospital mortality increased among patients who developed tamponade from 2008 to 2012 (p = 0.014). After multivariate adjustment for patient and hospital characteristics, female sex (odds ratio [OR]: 1.23; 95% confidence interval [CI]: 1.04 to 1.54; p = 0.011), dual-chamber pacemakers (OR: 1.68; 95% CI: 1.17 to 2.41; p < 0.004), and chronic liver disease (OR: 3.18; 95% CI: 1.92 to 5.64; p < 0.001) were found to be independently associated with a greater odds of cardiac tamponade. Conversely, hypertension (OR: 0.71; 95% CI: 0.45 to 0.94; p = 0.021) and atrial fibrillation (OR: 0.78; 95% CI; 0.61 to 0.96; p = 0.002) were associated with lower odds of tamponade.
The burden of cardiac tamponade associated with PPM implantation has steadily increased in the United States. Specific patient factors were identified that could predict the risk for developing tamponade among PPM recipients.
本研究旨在描述 2008 年至 2012 年期间美国接受永久性心脏起搏器 (PPM) 植入患者中心包填塞的趋势和预测因素。
关于 PPM 植入后患者发生填塞的负担、趋势和预测因素的数据有限。
使用全国 (全国范围) 住院患者样本数据库确定 2008 年至 2012 年期间接受 PPM 植入的患者。
在 2008 年至 2012 年间接受 PPM 装置的 922,549 名患者中，有 2595 名（0.28%）发生心包填塞。总体而言，接受 PPM 的患者中心包填塞的院内发生率增加了 35%。心包填塞的发生率从 2008 年的 0.26%稳步上升至 2012 年的 0.35%（p<0.0001）。尽管患者的平均年龄（p=0.28）和性别分布（p=0.25）多年来没有变化，但从 2008 年到 2012 年，发生填塞的患者的院内死亡率有所上升（p=0.014）。对患者和医院特征进行多变量调整后，女性（比值比[OR]：1.23；95%置信区间[CI]：1.04 至 1.54；p=0.011）、双腔起搏器（OR：1.68；95% CI：1.17 至 2.41；p<0.004）和慢性肝脏疾病（OR：3.18；95% CI：1.92 至 5.64；p<0.001）与心包填塞的可能性更大相关。相反，高血压（OR：0.71；95% CI：0.45 至 0.94；p=0.021）和心房颤动（OR：0.78；95% CI：0.61 至 0.96；p=0.002）与发生填塞的可能性较低相关。
美国与 PPM 植入相关的心包填塞负担稳步增加。确定了一些特定的患者因素，可以预测 PPM 接受者发生填塞的风险。
