背景:起搏器(PM)用于治疗具有严重心动过缓症状的患者。他们确实如此,然而,构成几个并发症。即使有这些风险,只有少数研究在资源有限的环境中评估PM植入结局,如埃塞俄比亚和其他撒哈拉以南国家.因此,本研究旨在通过确定并发症和死亡的发生率和预测因素,评估在埃塞俄比亚心脏中心接受PM植入的患者中,PM植入的中期结局.
方法:这项回顾性研究于2023年10月至2024年1月在埃塞俄比亚心脏中心对2012年9月至2023年8月进行了PM植入的患者进行评估,以评估患者的中期预后。并发症率和全因死亡率是我们研究的结果。多变量logistic回归分析与并发症和死亡相关的因素。为了分析生存时间,进行了Kaplan-Meier分析.
结果:这项回顾性随访研究包括182例患者,这些患者在2012年9月至2023年8月之间进行了PM植入,年龄至少为18岁。患者的中位随访时间为72个月(四分位距(IQR):36-96个月)。在研究结束时,26.4%的患者出现并发症。最常见的三种并发症是导线移位,这影响了6.6%的患者,PM引起的心动过速,影响了5.5%的患者,和早期的电池耗尽,这影响了5.5%的患者。年龄较大(调整后赔率比(AOR)1.1,95%CI1.04-1.1,p值<0.001),女性(AOR4.5,95CI2-9.9,p值<0.001),双腔PM(AOR2.95,95CI1.14-7.6,p值=0.006)是并发症的预测因子.31例(17%)患者在随访期间死亡。我们的患者在3年,5年和10年的生存率为94.4%,92.1%,和65.5%,中位生存时间为11年。PM植入前Charlson合并症指数较高的患者(AOR1.2,95%CI1.1-1.8,p=0.04),存在并发症(AOR3.5,95%CI1.2-10.6,p<0.03),纽约心脏协会(NYHA)III级或IV级(AOR3.3,95%CI1.05-10.1,p=0.04)与死亡率相关.
结论:植入PMs的患者会出现许多并发症,和几个因素影响他们的预后。因此,必须确定并发症和死亡率的预测因子,以优先考虑和解决与死亡率和并发症相关的可管理因素.
BACKGROUND: Pacemakers (PMs) are used to treat patients with severe bradycardia symptoms. They do, however, pose several complications. Even with these risks, there are only a few studies assessing PM implantation outcomes in resource-limited settings like Ethiopia and other sub-Saharan countries in general. Therefore, this study aims to assess the mid-term outcome of PM implantation in patients who have undergone PM implantation in the Cardiac Center of Ethiopia by identifying the rate and predictors of complications and death.
METHODS: This retrospective study was conducted at the Cardiac Center of Ethiopia from October 2023 to January 2024 on patients who had PM implantation from September 2012 to August 2023 to assess the midterm outcome of the patients. Complication rate and all-cause mortality rate were the outcomes of our study. Multivariable logistic regression was used to identify factors associated with complications and death. To analyze survival times, a Kaplan-Meier analysis was performed.
RESULTS: This retrospective follow-up study included 182 patients who underwent PM implantation between September 2012 and August 2023 and were at least 18 years old. The patients\' median follow-up duration was 72 months (Interquartile range (IQR): 36-96 months). At the end of the study, 26.4% of patients experienced complications. The three most frequent complications were lead dislodgement, which affected 6.6% of patients, PM-induced tachycardia, which affected 5.5% of patients, and early battery depletion, which affected 5.5% of patients. Older age (Adjusted Odds Ratio (AOR) 1.1, 95% CI 1.04-1.1, p value < 0.001), being female (AOR 4.5, 95%CI 2-9.9, p value < 0.001), having dual chamber PM (AOR 2.95, 95%CI 1.14-7.6, p value = 0.006) were predictors of complications. Thirty-one (17%) patients died during the follow-up period. The survival rates of our patients at 3, 5, and 10 years were 94.4%, 92.1%, and 65.5% respectively with a median survival time of 11 years. Patients with a higher Charlson comorbidity index before PM implantation (AOR 1.2, 95% CI 1.1-1.8, p = 0.04), presence of complications (AOR 3.5, 95% CI 1.2-10.6, p < 0.03), and New York Heart Association (NYHA) class III or IV (AOR 3.3, 95% CI 1.05-10.1, p = 0.04) were associated with mortality.
CONCLUSIONS: Many complications were experienced by patients who had PMs implanted, and several factors affected their prognosis. Thus, it is essential to identify predictors of both complications and mortality to prioritize and address the manageable factors associated with both mortality and complications.