Gill Jashan, Harb Ahmad, Varghese Jobin, Munshi Rezwan, Spooner Michael T
Department of Cardiology, MercyOne North Iowa Medical Center, Mason City, IA, USA.
Department of Medicine, Northwestern Medicine McHenry Hospital, McHenry, IL, USA.
J Innov Card Rhythm Manag. 2025 May 15;16(5):6272-6277. doi: 10.19102/icrm.2025.16053. eCollection 2025 May.
Increased age is associated with increased frailty and often worse postoperative outcomes. We sought to assess the safety of leadless pacemaker (LPM) insertion in the very elderly population. We queried the National Readmission Database for patients who underwent LPM insertion from 2017 to 2020. Patients aged ≥90 years were included in the nonagenarian group and compared to patients aged <90 years. Patient comorbidities were queried using the appropriate International Classification of Diseases, Tenth Revision, codes. We compared outcomes using multivariate logistic and linear regression, adjusting for patient comorbidities. At baseline, nonagenarians had higher prevalence rates of hypertension, a history of stroke, atrial fibrillation, atrial flutter, dementia, and hypothyroidism. The control group had more diabetes, coronary artery disease, chronic kidney disease, chronic pulmonary disease, oxygen use, coagulopathy, anemia, obesity, substance abuse, and chronic liver disease. Compared to controls, nonagenarians were found to have a shorter length of stay (2.5 days; < .001); lower mortality (adjusted odds ratio [aOR], 0.7; = .02); and lower rates of post-procedural cardiac arrest (aOR, 0.3; = .03), mechanical ventilation (aOR, 0.4; < .001), and vasopressor use (aOR, 0.6; = .001). Nonagenarians were only found to have an increased risk of pericardial complications (tamponade, pericardiocentesis, hemopericardium) (aOR, 1.6; = .02). There was no significant difference in 30-day readmissions (aOR, 0.97; = .7), postoperative bleed (aOR, 0.84; = .07), or stroke (aOR, 0.586; = .1). Our study demonstrates that LPM insertion could be safe in the very elderly population. However, our study likely demonstrates survivorship bias, as patients in the nonagenarian group had fewer overall comorbidities. Despite adjustment for known comorbidities, there remain confounders that are difficult to account for. Age itself does not seem to be a risk factor for worse outcomes in this population.
年龄增长与身体虚弱加剧相关，且术后结果往往更差。我们试图评估在高龄人群中植入无导线起搏器（LPM）的安全性。我们查询了国家再入院数据库中2017年至2020年期间接受LPM植入的患者。年龄≥90岁的患者被纳入九旬老人组，并与年龄<90岁的患者进行比较。使用适当的国际疾病分类第十版编码查询患者的合并症。我们使用多变量逻辑回归和线性回归比较结果，并对患者合并症进行了调整。在基线时，九旬老人组高血压、中风病史、心房颤动、心房扑动、痴呆和甲状腺功能减退的患病率较高。对照组有更多的糖尿病、冠状动脉疾病、慢性肾病、慢性肺病、吸氧、凝血障碍、贫血、肥胖、药物滥用和慢性肝病。与对照组相比，九旬老人组住院时间更短（2.5天；P<0.001）；死亡率更低（调整后的优势比[aOR]，0.7；P = 0.02）；术后心脏骤停发生率更低（aOR，0.3；P = 0.03）、机械通气发生率更低（aOR，0.4；P<0.001）以及血管升压药使用率更低（aOR，0.6；P = 0.001）。仅发现九旬老人组心包并发症（心包填塞、心包穿刺、心包积血）的风险增加（aOR，1.6；P = 0.02）。30天再入院率（aOR，0.97；P = 0.7）、术后出血（aOR，0.84；P = 0.07）或中风（aOR，0.586；P = 0.1）无显著差异。我们的研究表明，在高龄人群中植入LPM可能是安全的。然而，我们的研究可能存在生存偏差，因为九旬老人组患者的总体合并症较少。尽管对已知合并症进行了调整，但仍存在难以解释的混杂因素。在这一人群中，年龄本身似乎并不是导致预后更差的风险因素。
