Author + information
- Xiaofan Guoa,b,
- Robert Haywarda,b,
- Eric Vittinghoffa,b,
- Sun Yong Leea,b,
- Mark Pletchera,b and
- Byron Leea,b
Background: Cardiac device are increasingly required in the elderly, causing transvenous lead removal (TLR) more frequent than ever in this population. Safety of TLR in very elderly patients, especially those nonagenarians, is unknown.
Methods: We used Healthcare Cost and Utilization Project Nationwide Inpatient Sample to identify patients aged ≥ 70 years who underwent TLR from 2005 to 2012. Outcomes included in-hospital mortality and complications. Multivariable logistic regression models and hierarchical models adjusted for clinical and hospital- related confounders were used in analysis.
Results: We included a total of 36,099 patients aged 70 years or older undergoing TLR, 16,057 aged 70 to 79 years, 13,438 octogenarians and 2,287 nonagenarians. The in-hospital mortality rate was significantly higher in nonagenarians without device infection (0.9% in age 70-79 vs. 0.7% in age 80-89 vs. 2.6% in age ≥ 90, P=0.012). There was no significant difference between age groups in mortality rate among patients with infection. The overall complication rates were not different between age groups despite of infection status and comorbidity index (all P>0.05). Among the patients with device infection, octogenarian and nonagenarian were not associated with increased risk of in-hospital mortality relative to patients aged 70 to 79 years after controlling all the other confounders (for 80-89 age group: adjusted odd ratio [aOR] 0.98, 95% confidence interval [CI] 0.67-1.42, P=0.906; for ≥ 90 age group: aOR 1.31, 95% CI 0.64-2.65, P=0.457). However, among the patients without device infection, logistic regression showed significantly higher mortality in patients aged ≥ 90 years (aOR 4.22, 95% CI 1.66-10.75, P=0.003) but not in patients aged 80 to 89 years (aOR 1.05, 95% CI 0.48-2.30, P=0.907) compared with patients aged 70 to 79 years. Results using hierarchical models were consistent.
Conclusions: Among nonagenarians who had infection, mortality is driven more by the patient's other conditions, as the same for younger patients, rather than age per se. While for patients without infection, it is plausible to leave the leads in considering the higher acute mortality.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias and Clinical EP: Devices 3
Abstract Category: 5. Arrhythmias and Clinical EP: Devices
Presentation Number: 1188-074
- 2017 American College of Cardiology Foundation