Margolis Gilad, Hafner Oren Mahler, Kazatsker Mark, Roguin Ariel, Leshem Eran
Division of Cardiovascular Medicine, Hillel Yaffe Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
Division of Cardiovascular Medicine, Hillel Yaffe Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
JACC Adv. 2025 Jun;4(6 Pt 1):101768. doi: 10.1016/j.jacadv.2025.101768. Epub 2025 May 13.
Pre-existing pulmonary hypertension (PH) is associated with unfavorable in-hospital outcomes in cardiac as well as noncardiac surgeries and procedures. However, its impact on cardiac implantable electronic device (CIED) implantations is not established.
The purpose of the study was to investigate the extent of pre-existing PH among patients undergoing CIED implantations and to evaluate its effect on in-hospital outcomes.
Using the National Inpatient Sample database, we identified patients who were hospitalized in the United States between 2016 and 2019 and underwent CIED implantation with a pre-existing diagnosis of PH. Patients with any CIED in situ were excluded. Sociodemographic and clinical data, in-hospital procedures and outcomes, and in-hospital mortality were collected. Multivariable logistic regression models were used to identify predictors of in-hospital complications.
An estimated total of 718,980 patients underwent CIED implantation during the study period. Of them, 74,150 patients (10.3%) had a pre-existing PH diagnosis. Compared with non-PH patients, PH patients were older, had higher Charlson Comorbidity Index, and were more often implanted with implantable cardioverter defibrillators and cardiac resynchronization therapy devices. A higher rate of total complications was observed in PH patients (14.5% vs 9.9%; P < 0.001), driven mainly by respiratory complications as well as in-hospital mortality (2.3% vs 1.2%; P < 0.001). Multivariable analyses confirmed PH as an independent predictor for respiratory complications, total complications, and in-hospital mortality.
Pre-existing PH in patients undergoing CIED implantation was associated with increased risk for respiratory complications as well as in-hospital mortality in a nationwide, all-comer registry.
既往存在的肺动脉高压（PH）与心脏手术以及非心脏手术和操作的不良院内结局相关。然而，其对心脏植入式电子设备（CIED）植入的影响尚未明确。
本研究旨在调查接受CIED植入的患者中既往存在PH的程度，并评估其对院内结局的影响。
利用全国住院患者样本数据库，我们识别出2016年至2019年期间在美国住院并接受CIED植入且既往诊断为PH的患者。排除任何原位有CIED的患者。收集社会人口统计学和临床数据、院内操作和结局以及院内死亡率。使用多变量逻辑回归模型来识别院内并发症的预测因素。
在研究期间，估计共有718,980例患者接受了CIED植入。其中，74,150例患者（10.3%）既往有PH诊断。与非PH患者相比，PH患者年龄更大，Charlson合并症指数更高，且更常植入植入式心律转复除颤器和心脏再同步治疗设备。PH患者的总并发症发生率更高（14.5%对9.9%；P<0.001），主要由呼吸系统并发症以及院内死亡率驱动（2.3%对1.2%；P<0.001）。多变量分析证实PH是呼吸系统并发症、总并发症和院内死亡率的独立预测因素。
在一项全国性的、所有患者的登记研究中，接受CIED植入的患者中既往存在的PH与呼吸系统并发症风险增加以及院内死亡率增加相关。
