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慢性肾脏病对室性心动过速导管消融住院死亡率和临床结局的影响:来自全国再入院数据库的见解。

Impact of chronic kidney disease on in-hospital mortality and clinical outcomes of catheter ablation of ventricular tachycardia: Insights from the national readmission database.

机构信息

Internal Medicine Department Lincoln Medical and Mental Health Center, NY, New York, USA.

Cardiovascular Medicine Department, Tanta University, Tanta, Egypt.

出版信息

J Interv Card Electrophysiol. 2023 Mar;66(2):323-331. doi: 10.1007/s10840-022-01187-z. Epub 2022 Mar 22.

Abstract

BACKGROUND

Catheter ablation is an effective treatment for ventricular tachycardia (VT), albeit the decision to undergo this procedure is often influenced by underlying comorbidities. The present study aims at evaluating the effects of chronic kidney disease (CKD) on clinical outcomes of VT ablation.

METHODS

We identified 7212 patients who presented between 2016 and 2018 and underwent catheter ablation for VT. Their clinical data were retrospectively accrued from the national readmission database (NRD) using the corresponding diagnosis codes. We compared clinical outcomes between patients with chronic kidney disease (CKD group) and patients without. Odds ratios (OR) for the primary and secondary outcomes were calculated, and multivariable regression analysis was utilized to adjust for confounding variables.

RESULTS

Compared with patients without CKD, patients in CKD group were older (mean age 67.9 vs. 60.5 years, P < 0.01), had a longer mean length of stay (8.73 vs. 5.69 days, P < 0.01), and higher in-hospital mortality 113 (6.7%) vs. 119 (2.2%) (OR 2.24, 95% confidence interval (CI) (1.29-3.88), P < 0.01). CKD group patients had increased risk of developing acute kidney injury 726 (43%) vs. 623 (11.3%) (3.69 95% CI (2.87-4.74), P < 0.01).

CONCLUSION

In patients with CKD, VT ablation is associated with worse clinical outcomes in-hospital mortality, acute kidney injury, mean length of stay, and total hospital charge. This significantly influences the decision-making prior to performing this procedure.

摘要

背景

导管消融术是治疗室性心动过速(VT)的有效方法,但进行该手术的决定通常受到潜在合并症的影响。本研究旨在评估慢性肾脏病(CKD)对 VT 消融临床结果的影响。

方法

我们从国家再入院数据库(NRD)中使用相应的诊断代码回顾性地收集了 2016 年至 2018 年间接受导管消融治疗 VT 的 7212 例患者的临床数据。我们比较了慢性肾脏病(CKD 组)患者和非 CKD 患者的临床结果。计算了主要和次要结局的优势比(OR),并使用多变量回归分析调整混杂变量。

结果

与非 CKD 患者相比,CKD 组患者年龄更大(平均年龄 67.9 岁比 60.5 岁,P<0.01),平均住院时间更长(8.73 天比 5.69 天,P<0.01),住院死亡率更高(113 例[6.7%]比 119 例[2.2%],OR 2.24,95%置信区间(CI)(1.29-3.88),P<0.01)。CKD 组患者发生急性肾损伤的风险增加(726 例[43%]比 623 例[11.3%],3.69 95%CI(2.87-4.74),P<0.01)。

结论

在 CKD 患者中,VT 消融术与住院死亡率、急性肾损伤、平均住院时间和总住院费用等临床结局较差相关。这显著影响了进行该手术的决策。

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