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Risk score to assess mortality risk in patients undergoing transvenous lead extraction
Ewa Oszczygieł1, Andrzej Kutarski2, Andrzej Oszczygieł3
1Department of Cardiology and Heart Rhythm Disorders, Medical University, Łódź, Poland.
Insights
This study found that the IKAR risk score effectively predicts 1-year mortality after transvenous lead extraction (TLE). Higher scores indicate increased mortality risk in patients undergoing TLE procedures.
Area of Science:
- Cardiology
- Medical Device Technology
- Infectious Diseases
Background:
- Transvenous lead extraction (TLE) is a critical procedure for managing cardiac electronic device complications.
- Assessing mortality risk factors following TLE is essential for patient management and resource allocation.
Purpose of the Study:
- To evaluate 1-year mortality rates in patients undergoing TLE.
- To identify predictors of mortality in this patient cohort.
- To develop a predictive risk score for post-TLE mortality.
Main Methods:
- Retrospective analysis of 130 patients undergoing TLE between June 2006 and October 2014.
- Data collection included patient demographics, device types, extraction indications, and 1-year follow-up.
- Statistical analysis to identify predictors of mortality and develop the IKAR risk score.
Main Results:
- The 1-year cumulative mortality was 28%.
- Predictors of higher mortality included older age, chronic kidney disease, infection as an indication for TLE, and removal of high-voltage leads.
- The developed IKAR risk score (Infection, Kidney dysfunction, Age, Removal of high-voltage lead) demonstrated significant predictive value, with scores ≥3 associated with 79% mortality.
Conclusions:
- The IKAR risk score is a valuable tool for predicting 1-year mortality in patients undergoing TLE.
- This score can aid clinicians in stratifying patient risk and guiding management decisions.
- Further validation of the IKAR score in diverse populations is warranted.
Aims:
The main aim of this study was to assess 1-year mortality and its predictors in a cohort of patients who underwent transvenous lead extraction (TLE) procedure.
Methods:
Retrospective analysis of clinical characteristics and 1-year follow-up of patients referred for a TLE procedure in a single, high-volume center between June 2006 and October 2014 was performed.
Results:
The studied population included 130 patients (82 males; mean age 64 ± 15 years) implanted with pacemakers (74%), implantable cardioverter defibrillators (15%), or cardiac resynchronization therapy defibrillator (11%). Indications for the extraction included infective endocarditis (40.5%), pocket infection (18.5%), and lead fault or failure (41%). Total radiological success rate was 90% while clinical success rate was 93.5%. The cumulative 1-year mortality was 28%. Mortality was higher in a group of older patients (94.4% vs 68%, P = 0.001) and those with chronic kidney disease (33.3% vs 4.3 %, P = 0.0002) as well as in patients after removal of high voltage lead (88.9% vs 26.3%, P = 0.01). Higher mortality was also related to infection as an indication for TLE (37.2% vs 13.5%, P = 0.002). Following these findings a new risk score model named IKAR (I = infective indications; K = kidney dysfunction; A = age ≥ 56; R = removal of high voltage lead) was constructed. Patients with IKAR score ≥3 points were characterized by 79% mortality as compared to 16% in those with a score 1-2 points.
Conclusions:
One-year mortality of patients undergoing TLE procedure can be predicted by using IKAR risk score.
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