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Transvenous lead extraction: The influence of age on patient outcomes in the PROMET study cohort
Author(s) -
Akhtar Zaki,
Elbatran Ahmed I.,
Starck Christoph T.,
Gonzalez Elkin,
AlRazzo Omar,
Mazzone Patrizio,
Delnoy PeterPaul,
Breitenstein Alexander,
Steffel Jan,
EulertGrehn Jürgen,
Lanmüller Pia,
Melillo Francesco,
Marzi Alessandra,
Leung Lisa W.M.,
Domenichini Giulia,
Sohal Manav,
Gallagher Mark M.
Publication year - 2021
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.14310
Subject(s) - medicine , propensity score matching , cohort , multivariate analysis , demographics , pediatrics , age groups , population , young adult , retrospective cohort study , cohort study , surgery , demography , environmental health , sociology
Background Cardiac implantable electronic device (CIED) therapy contributes to an improvement in morbidity and mortality across all patient demographics. Patient age is a recognized risk factor for unfavorable outcomes in invasive procedures. This is the largest series of non‐laser transvenous lead extraction (TLE) evaluating the association between patient age and procedure outcomes. Methods Data of 2205 (3849 leads) patients was collected retrospectively from six European TLE centers between January 2005–December 2018 in the PROMET study. Of these, 153 patients with 319 leads were excluded for incomplete data. A comparison of outcomes was performed between the age groups young [< 50 years], young intermediate [50–69 years], older intermediate [70–79 years], and octogenarian [≥80 years]. Results Infection was most common indication for TLE in the octogenarian cohort, less common in the younger population (60.1% vs. 33.2%, respectively, p < .01). High‐voltage leads were extracted most frequently from young patients, less frequently from octogenarians (31.6% vs. 10%, p < .001), while the opposite was evident for pacemaker leads ( p < .001). Rotational sheath use was equally prevalent across all patient groups ( p = .79). Minor and major complications across all the age groups were statistically similar, as was procedural success; the 30‐day mortality was most significant in the octogenarian and least in the young patients (4.9% vs. 0.4%, p = .005). Propensity matching multivariate analysis found systemic infection, lead dwell time, and patient age ( p = .013, OR 1.064 [1.013–1.116]) increased risk of 30‐day mortality. Conclusion TLE is safe and effective across all age groups. 30‐day mortality risk is significantly higher in the older patients.