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Published on: June 12, 2021
Impact of prior permanent pacemaker on long-term clinical outcomes of patients undergoing percutaneous coronary
Yan-Jie Li1,2, Wei-Wei Zhang1, Xiao-Xiao Yang1
1Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
Insights
Permanent pacemaker (PPM) use in patients undergoing percutaneous coronary intervention (PCI) does not impact mortality but significantly increases heart failure (HF) hospitalizations, particularly in acute coronary syndrome (ACS) patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- The long-term clinical outcomes of patients with permanent pacemakers (PPM) undergoing percutaneous coronary intervention (PCI) remain understudied.
- PPM implantation may exacerbate heart failure (HF) burden in patients undergoing PCI.
Purpose of the Study:
- To investigate the impact of PPM on long-term clinical outcomes, specifically all-cause mortality and HF hospitalization, in patients undergoing first-time PCI.
- To assess whether PPM influences the risk of HF hospitalization in patients with acute coronary syndrome (ACS) undergoing PCI.
Main Methods:
- A nested case-control study design was employed, matching patients with PPM undergoing first PCI to controls without PPM 1:1 by age and sex.
- Clinical data were collected and analyzed, with primary endpoints including all-cause mortality and HF-related hospitalizations.
- Subgroup analysis was performed for patients with ACS.
Main Results:
- The study included 156 patients with a mean follow-up of 4.6 years. All-cause mortality did not differ significantly between groups (21.79% vs 20.51%, P = 0.85).
- Patients with PPM showed a significantly higher rate of HF-related hospitalization compared to controls (26.92% vs 10.26%, P = 0.008).
- In the ACS subgroup, VVI-mode pacing was associated with an increased risk of HF hospitalization (adjusted odds ratio: 8.27, P = 0.02).
Conclusions:
- Permanent pacemaker implantation does not affect all-cause mortality in patients undergoing their first PCI.
- PPM significantly increases the rate of heart failure-associated hospitalizations in patients undergoing PCI.
- The risk of HF hospitalization is particularly elevated in ACS patients with PPM, especially with VVI-mode pacing.
Background:
The impact of permanent pacemaker (PPM) on long-term clinical outcomes of patients undergoing percutaneous coronary intervention (PCI) has not been studied.
Hypothesis:
PPM may increase heart failure (HF) burden on patients undergoing PCI.
Methods:
We recruited consecutive patients undergoing PCI and carried out a nested case-control study. Patients with confirmed PPM undergoing first PCI were identified and matched by age and sex in 1:1 fashion to patients without PPM undergoing first PCI. Clinical data were collected and analyzed. The primary endpoint outcomes were all-cause mortality and hospitalization for HF.
Results:
The final analysis included 156 patients. The mean follow-up period was 4.6 ± 2.9 years. The overall all-cause mortality was 21.15%, without significant difference between the 2 groups (21.79% vs 20.51%; P = 0.85). However, the rate of HF-related hospitalization was significantly higher in patients with PPM than in controls (26.92% vs 10.26%; P = 0.008). After adjustment for hypertension, type 2 diabetes mellitus, hyperlipidemia, chronic kidney disease, stroke, left ventricular ejection fraction, brain natriuretic peptide, and acute coronary syndrome (ACS), PCI patients with PPM were still associated with a greater hospitalization rate for HF (odds ratio: 4.31, 95% confidence interval: 0.94-19.80, P = 0.061). Further analysis in the ACS subgroup showed VVI-mode pacing enhanced the risk for HF-associated hospitalization (adjusted odds ratio: 8.27, 95% confidence interval: 1.37-49.75, P = 0.02).
Conclusions:
PPM has no effect on all-cause mortality in patients undergoing first PCI but significantly increases the HF-associated hospitalization rate, especially in ACS patients.
