Abstract:
:Background Patients undergoing lead extraction for infected devices have worse outcomes compared with those with noninfected devices. We assessed predictors of in-hospital mortality and procedure-related major adverse events (MAEs) in a large cohort undergoing lead extraction. Methods and Results Deidentified hospital records procedure from 7 states between 1994 and 2013 were aggregated and International Classification of Disease, Ninth Revision (ICD-9) procedure codes were used to identify hospital records reporting lead extraction. MAEs included death, cardiac tamponade, hemothorax, and need for emergent cardiac surgery. Predictors of in-hospital MAEs for infected compared with noninfected leads were identified using multivariate regression. Associations between outcomes and specific microbe were also assessed. In total, 57 220 discharges specified lead extraction. Infected leads accounted for the minority of total lead extractions compared with fractured leads (16.1 versus 59.8%, 25.7% not reported). There were 3298 MAEs (5.8%) including 980 deaths (1.7%). Multivariate predictors of MAE included black race, atrial fibrillation, anemia, heart failure, and admission via either hospital transfer or emergency department versus home (all P<0.001). Infected leads were associated with an increased risk of death (4.6% versus 0.9%, P<0.001) compared with leads with fracture only. Among patients with microbial data, staphylococcal infection was most common, whereas streptococcal infection was associated with the worst outcomes. Conclusions Patients undergoing extraction of infected leads have higher in-hospital mortality and adverse events compared with noninfected leads. Streptococcus, anemia, and heart failure are predictors of adverse outcomes.
journal_name
J Am Heart Assocjournal_title
Journal of the American Heart Associationauthors
Aleong RG,Zipse MM,Tompkins C,Aftab M,Varosy P,Sauer W,Kao Ddoi
10.1161/JAHA.118.011473subject
Has Abstractpub_date
2020-04-07 00:00:00pages
e011473issue
7issn
2047-9980journal_volume
9pub_type
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journal_title:Journal of the American Heart Association
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doi:10.1161/JAHA.118.010269
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doi:10.1161/JAHA.117.006717
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doi:10.1161/JAHA.118.009627
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doi:10.1161/JAHA.119.014940
更新日期:2020-03-03 00:00:00
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pub_type: 杂志文章,多中心研究
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journal_title:Journal of the American Heart Association
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doi:10.1161/JAHA.119.012406
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journal_title:Journal of the American Heart Association
pub_type: 杂志文章
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pub_type: 杂志文章,多中心研究
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doi:10.1161/JAHA.119.012078
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doi:10.1161/JAHA.119.012008
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pub_type: 杂志文章
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doi:10.1161/JAHA.119.013296
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doi:10.1161/JAHA.116.003350
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abstract::See Editorial by Cenko et al. ...
journal_title:Journal of the American Heart Association
pub_type: 评论,社论
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更新日期:2019-02-19 00:00:00
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pub_type: 杂志文章,多中心研究
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journal_title:Journal of the American Heart Association
pub_type: 杂志文章
doi:10.1161/JAHA.118.011021
更新日期:2019-02-19 00:00:00