1 College of Medicine and Public Health Flinders University Bedford Park South Australia.
4 Discipline of Medicine University of Adelaide South Australia.
J Am Heart Assoc. 2019 Jan 22;8(2):e010869. doi: 10.1161/JAHA.118.010869.
Background To date, limited population-level studies have examined the impact of sex on the acute complications of cardiac implantable electronic devices ( CIED) , including permanent pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization therapy devices. Methods and Results We studied all patients aged >18 years from 2010 to 2015 who were a resident of Australia or New Zealand, undergoing a new permanent pacemaker, implantable cardioverter defibrillator, or cardiac resynchronization therapy implant. Standardized variables were collected including patient demographic characteristics, primary and secondary diagnoses, procedures performed and discharge status. Diagnoses and procedures were coded as per the International Classification of Diseases, Tenth Revision ( ICD-10) and the Australian Classification of Health Interventions. The primary end point was the incidence of major CIED -related complications in-hospital or within 90 days of discharge, with the effect of sex evaluated using multiple logistic regression. A total of 81 304 new CIED (61 658 permanent pacemakers, 12 097 implantable cardioverter defibrillators, 7574 cardiac resynchronization therapy) implants were included (38% women). Overall, 8.5% of women and 8.0% of men experienced a CIED complication ( P=0.008). Differences between women and men remained significant after adjustment for age, procedural acuity, and comorbidities (odds ratio 1.10, 95% CI: 1.04-1.16, P<0.001). Differences in CIED complication rates were primarily driven by excess rate of in-hospital pleural drainage (1.2% women versus 0.6% men, P<0.001; adjusted odds ratio 1.86, 95% CI: 1.59-2.17, P<0.001) and pericardial drainage (0.3% women versus 0.1% men, P<0.001; adjusted odds ratio 2.17, 95% CI: 1.48-3.18, P<0.001). Conclusions Women are at higher risk of acute CIED complications. Improvements in implant technique and technologies are required to minimize the risk of implant-related complications in women.
迄今为止，有限的人群研究调查了性别对心脏植入式电子设备（CIED）的急性并发症的影响，包括永久性起搏器、植入式心律转复除颤器和心脏再同步治疗设备。
我们研究了 2010 年至 2015 年期间，居住在澳大利亚或新西兰的所有年龄大于 18 岁的新植入永久性起搏器、植入式心律转复除颤器或心脏再同步治疗的患者。收集了标准化变量，包括患者的人口统计学特征、主要和次要诊断、进行的手术和出院情况。诊断和手术均按照国际疾病分类第十版（ICD-10）和澳大利亚卫生干预分类进行编码。主要终点是住院期间或出院后 90 天内主要 CIED 相关并发症的发生率，使用多变量逻辑回归评估性别影响。共纳入 81304 例新 CIED（61658 例永久性起搏器、12097 例植入式心律转复除颤器、7574 例心脏再同步治疗）植入（38%为女性）。总体而言，8.5%的女性和 8.0%的男性经历了 CIED 并发症（P=0.008）。在调整年龄、手术紧迫性和合并症后，女性和男性之间的差异仍然显著（比值比 1.10，95%CI：1.04-1.16，P<0.001）。CIED 并发症发生率的差异主要归因于女性胸腔引流（1.2%比 0.6%，P<0.001；调整后的比值比 1.86，95%CI：1.59-2.17，P<0.001）和心包引流（0.3%比 0.1%，P<0.001；调整后的比值比 2.17，95%CI：1.48-3.18，P<0.001）的发生率较高。
女性发生急性 CIED 并发症的风险更高。需要改进植入技术和技术，以最大程度地降低女性与植入物相关并发症的风险。
