背景:关于年龄和合并症对无引线起搏器(LPM)患者预后影响的知识有限。
目的:根据年龄和合并症分析LPM患者的预后。
方法:这个瑞士人,多中心,回顾性分析包括2015年至2022年间所有LPM植入患者.确定Charlson合并症指数(CCI),并将患者分为低合并症(CCI≤5)和高合并症(CCI>5)组。围手术期并发症,在医院死亡,并评估了所有原因的死亡率。最后,将三组(CCI≤3,4-5,>5)的全因死亡率与一般瑞士人群的年龄和性别调整死亡率进行比较.
结果:863例患者(中位年龄81岁,65%男性,包括CCI>5)的42%。围手术期/长期并发症发生率在低与高共病组(2.6%与1.7%,p=0.48和1.2%与2.8%,分别为p=0.12)。住院(3.6%与0.6%,p=0.002)和全因死亡率(HR2.9,95CI2.2-3.8,p<0.001)在高共病组中明显更高,导致三年死亡率为58%(95CI51-65%)。低共病组为22%(95CI17-27%)。在CCI≤3的患者中,全因死亡率与一般瑞士人群的年龄和性别调整死亡率相当。
结论:在高合并症的老年患者中,LPM植入与围手术期/长期并发症的增加无关。CCI≤3的LPM患者的全因死亡率与一般瑞士人群的年龄和性别调整死亡率相当。尽管由于竞争的风险因素,三年死亡率相对较高,LPM植入是安全的,即使是高同病的老年患者。
结论:在这个瑞士人中,多中心,回顾性队列分析,纳入863例植入无引线起搏器的患者,并将其分为高合并症(CCI>5)和低合并症(CCI≤5)组。在植入结果和围手术期或长期并发症方面,组间没有差异。此外,CCI≤3患者随访期间的全因死亡率与一般瑞士人群中年龄和性别校正死亡率相当.这些数据表明LPM植入是一种安全的手术,即使是高同病的老年患者。
BACKGROUND: Knowledge about impact of age and comorbidities on outcome in patients with leadless pacemakers (LPM) is limited.
OBJECTIVE: To analyse outcome in LPM patients according to age and comorbidities.
METHODS: This Swiss, multi-centre, retrospective analysis includes all patients with LPM implanted between 2015 and 2022. Charlson-Comorbidity-Index (CCI) was determined and patients were divided into a low- (CCI ≤ 5) and high- comorbidity (CCI > 5) group. Peri-procedural complications, in-hospital death, and all-cause mortalities were assessed. Finally, all-cause mortality according to three groups (CCI ≤ 3, 4-5, >5) was compared to age and sex-adjusted mortality in the general Swiss population.
RESULTS: 863 patients (median age 81 years, 65% male, 42% with CCI > 5) were included. Peri-procedural/long-term complication rates did not differ between the low- vs. high-comorbidity groups (2.6% vs. 1.7%, p = 0.48 and 1.2% vs. 2.8%, p = 0.12, respectively). In-hospital (3.6% vs. 0.6%, p = 0.002) and all-cause mortality (HR 2.9, 95%CI 2.2-3.8, p < 0.001) were significantly higher in the high-comorbidity group resulting in a three-year mortality of 58% (95%CI 51-65%) vs. 22% (95%CI 17-27%) in the low-comorbidity group. In patients with a CCI ≤ 3, all-cause mortality was comparable to the age- and sex-adjusted mortality of the general Swiss population.
CONCLUSIONS: In elderly patients with high comorbidity, LPM implantation was not associated with increased peri-procedural/long-term complications. All-cause mortality in LPM patients with a CCI ≤ 3 was comparable to age- and sex-adjusted mortality in the general Swiss population. Despite a relatively high three-year mortality due to competing risk factors, LPM implantation is safe, even in elderly patients with high comorbidity.
CONCLUSIONS: In this Swiss, multi-centre, retrospective cohort analysis, 863 patients implanted with a leadless pacemaker were included and divided into a high-comorbidity (with a CCI > 5) and low-comorbidity (with a CCI ≤ 5) group. There was no between group difference in terms of implantation outcomes and peri-operative or long-term complications. Furthermore, all-cause mortality during follow-up in patients with a CCI ≤ 3 was comparable to age- and sex-adjusted mortality in the general Swiss population. These data indicate that LPM implantation is a safe procedure, even in elderly patients with high comorbidity.