心臓植込み型電子機器処置後のポケット血腫に対するCALLY指数の予測値

Pocket hematoma is one of the most common early complications after cardiac implantable electronic device (CIED) procedures and is associated with increased morbidity. Reliable risk stratification tools are needed to identify patients at higher risk.

In this retrospective single-center study, 158 patients who underwent CIED implantation between January 2024 and June 2025 were analyzed. Patients who developed a pocket hematoma (n = 35) were compared with those without a hematoma (n = 123). Demographic, clinical, laboratory, and procedural parameters were assessed. The Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, and Drugs/alcohol score (HAS-BLED) and C-reactive protein-albumin-lymphocyte (CALLY) index were calculated. Logistic regression analysis was performed to identify predictors of hematoma, and receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic performance of the CALLY index.

Of the 158 patients analyzed, 35 (22.2%) developed a hematoma, while 123 (77.8%) did not and served as the control group. In univariate analysis, warfarin use, elevated HbA1c, reduced glomerular filtration rate (GFR), higher pro-B-type natriuretic peptide (proBNP), and lower CALLY index were significantly associated with hematoma, although none retained significance in multivariate analysis. The CALLY index demonstrated modest discriminatory power (AUC 0.629, p = 0.023) with high negative predictive value (92.1%) but limited positive predictive value (29.3%). The HAS-BLED score showed no significant predictive ability.

The CALLY index was associated with pocket hematoma after CIED implantation, whereas the HAS-BLED score showed limited predictive value. This simple and inexpensive index may aid pre-procedural risk stratification, although prospective multicenter studies are needed to validate its utility.