Talaei Fahimeh, Ang Qi-Xuan, Tan Min-Choon, Hassan Mustafa, Scott Luis, Cha Yong-Mei, Lee Justin Z, Tamirisa Kamala
Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA.
Department of Internal Medicine, McLaren Health System and Michigan State University, Flint, MI, USA.
J Interv Card Electrophysiol. 2024 Oct;67(7):1517-1527. doi: 10.1007/s10840-024-01775-1. Epub 2024 Mar 9.
Transvenous lead removal (TLR) is associated with increased mortality and morbidity. This study sought to evaluate the impact of TLR on in-hospital mortality and outcomes in patients with and without CIED infection.
From January 1, 2017, to December 31, 2020, we utilized the nationally representative, all-payer, Nationwide Readmissions Database to assess patients who underwent TLR. We categorized TLR as indicated for infection, if the patient had a diagnosis of bacteremia, sepsis, or endocarditis during the initial admission. Conversely, if none of these conditions were present, TLR was considered sterile. The impact of infective vs sterile indications of TLR on mortality and major adverse events was studied.
Out of the total 25,144 patients who underwent TLR, 14,030 (55.8%) received TLR based on sterile indications, while 11,114 (44.2%) received TLR due to device infection, with 40.5% having systemic infection and 59.5% having isolated pocket infection. TLR due to infective indications was associated with a significant in-hospital mortality (5.59% vs 1.13%; OR = 5.16; 95% CI 4.33-6.16; p < 0.001). Moreover, when compared with sterile indications, TLR performed due to device infection was associated with a considerable risk of thromboembolic events including pulmonary embolism and stroke (OR = 3.80; 95% CI 3.23-4.47, p < 0.001). However, there was no significant difference in the conversion to open heart surgery (1.72% vs. 1.47%, p < 0.111), and infection was not an independent predictor of cardiac (OR = 1.12; 95% CI 0.97-1.29) or vascular complications (OR = 1.12; 95% CI 0.73-1.72) between the two groups.
Higher in-hospital mortality and rates of thromboembolic events associated with TLR resulting from infective indications may warrant further pursuing this diagnosis in patients.
经静脉导线拔除术（TLR）与死亡率和发病率增加相关。本研究旨在评估TLR对有或无心脏植入电子设备（CIED）感染患者的院内死亡率和结局的影响。
从2017年1月1日至2020年12月31日，我们利用具有全国代表性的全付费者全国再入院数据库来评估接受TLR的患者。如果患者在初次入院期间诊断为菌血症、脓毒症或心内膜炎，我们将TLR归类为因感染而进行。相反，如果不存在这些情况，则TLR被视为无菌性的。研究了TLR的感染性与无菌性指征对死亡率和主要不良事件的影响。
在总共25144例接受TLR的患者中，14030例（55.8%）基于无菌性指征接受TLR，而11114例（44.2%）因设备感染接受TLR，其中40.5%有全身感染，59.5%有孤立的囊袋感染。因感染性指征进行的TLR与显著的院内死亡率相关（5.59%对1.13%；OR = 5.16；95% CI 4.33 - 6.16；p < 0.001）。此外，与无菌性指征相比，因设备感染进行的TLR与包括肺栓塞和中风在内的血栓栓塞事件的相当大风险相关（OR = 3.80；95% CI 3.23 - 4.47，p < 0.001）。然而，转为心脏直视手术方面无显著差异（1.72%对1.47%，p < 0.111），并且两组之间感染不是心脏（OR = 1.12；95% CI 0.97 - 1.29）或血管并发症（OR = 1.12；95% CI 0.73 - 1.72）的独立预测因素。
因感染性指征导致的TLR相关的较高院内死亡率和血栓栓塞事件发生率可能值得对患者进一步追查该诊断。
