Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland.
Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland.
Int J Cardiol. 2024 Nov 15;415:132453. doi: 10.1016/j.ijcard.2024.132453. Epub 2024 Aug 14.
Knowledge about impact of age and comorbidities on outcome in patients with leadless pacemakers (LPM) is limited.
To analyse outcome in LPM patients according to age and comorbidities.
This Swiss, multi-centre, retrospective analysis includes all patients with LPM implanted between 2015 and 2022. Charlson-Comorbidity-Index (CCI) was determined and patients were divided into a low- (CCI ≤ 5) and high-comorbidity (CCI > 5) group. Peri-procedural complications, in-hospital death, and all-cause mortalities were assessed. Finally, all-cause mortality according to three groups (CCI ≤ 3, 4-5, >5) was compared to age and sex-adjusted mortality in the general Swiss population.
863 patients (median age 81 years, 65% male, 42% with CCI > 5) were included. Peri-procedural/long-term complication rates did not differ between the low- vs. high-comorbidity groups (2.6% vs. 1.7%, p = 0.48 and 1.2% vs. 2.8%, p = 0.12, respectively). In-hospital (3.6% vs. 0.6%, p = 0.002) and all-cause mortality (HR 2.9, 95%CI 2.2-3.8, p < 0.001) were significantly higher in the high-comorbidity group resulting in a three-year mortality of 58% (95%CI 51-65%) vs. 22% (95%CI 17-27%) in the low-comorbidity group. In patients with a CCI ≤ 3, all-cause mortality was comparable to the age- and sex-adjusted mortality of the general Swiss population.
In elderly patients with high comorbidity, LPM implantation was not associated with increased peri-procedural/long-term complications. All-cause mortality in LPM patients with a CCI ≤ 3 was comparable to age- and sex-adjusted mortality in the general Swiss population. Despite a relatively high three-year mortality due to competing risk factors, LPM implantation is safe, even in elderly patients with high comorbidity.
In this Swiss, multi-centre, retrospective cohort analysis, 863 patients implanted with a leadless pacemaker were included and divided into a high-comorbidity (with a CCI > 5) and low-comorbidity (with a CCI ≤ 5) group. There was no between group difference in terms of implantation outcomes and peri-operative or long-term complications. Furthermore, all-cause mortality during follow-up in patients with a CCI ≤ 3 was comparable to age- and sex-adjusted mortality in the general Swiss population. These data indicate that LPM implantation is a safe procedure, even in elderly patients with high comorbidity.
关于无导线起搏器（LPM）患者年龄和合并症对预后影响的知识有限。
根据年龄和合并症分析 LPM 患者的预后。
本研究为瑞士多中心回顾性分析，纳入 2015 年至 2022 年期间植入 LPM 的所有患者。确定 Charlson 合并症指数（CCI），并将患者分为低合并症（CCI≤5）和高合并症（CCI>5）组。评估围手术期并发症、院内死亡和全因死亡率。最后，将全因死亡率根据 CCI（CCI≤3、4-5、>5）与瑞士一般人群的年龄和性别调整死亡率进行比较。
共纳入 863 例患者（中位年龄 81 岁，65%为男性，42%有 CCI>5）。低合并症组与高合并症组之间的围手术期/长期并发症发生率无差异（分别为 2.6%与 1.7%，p=0.48 和 1.2%与 2.8%，p=0.12）。高合并症组院内（3.6%与 0.6%，p=0.002）和全因死亡率（HR 2.9，95%CI 2.2-3.8，p<0.001）显著更高，导致三年死亡率为 58%（95%CI 51-65%），而低合并症组为 22%（95%CI 17-27%）。CCI≤3 的患者全因死亡率与瑞士一般人群的年龄和性别调整死亡率相当。
在高龄、合并症较多的患者中，LPM 植入术与围手术期/长期并发症增加无关。CCI≤3 的 LPM 患者的全因死亡率与瑞士一般人群的年龄和性别调整死亡率相当。尽管由于竞争风险因素，三年死亡率较高，但 LPM 植入术是安全的，即使在合并症较多的高龄患者中也是如此。
