BACKGROUND: For each clinical circumstance, the benefits of transvenous lead extraction (TLE) need to be weighed against the risks. Clinical decision-making tools for predicting mortality after TLE are lacking. OBJECTIVE: To create a preoperative risk score for prediction of 30-day all-cause mortality after TLE of pacemaker and defibrillator leads. METHODS: Consecutive patients undergoing TLE at the Cleveland Clinic between August 1996 and August 2011 were included in the analysis. A risk nomogram for predicting 30-day all-cause mortality was developed using baseline clinical variables and multivariable logistic regression modeling. Discrimination and calibration were assessed by using bootstrapping for internal validation. Continuous data are presented as median (25th, 75th percentile); categorical data are presented as number (percentage). RESULTS: A total of 5521 (4137 [74.9%] pacemaker and 1384 [25.1%] defibrillator) leads were extracted during 2999 TLE procedures (patient age 67.2 [55.2, 76.2] years, 30.2% female). Lead implant duration was 4.7 (2.4, 8.3) years and 2.0 (1.0, 2.0) leads were extracted per procedure. Sixty-seven patients (2.2%) had died by 30 days after TLE. Variables with the highest predictive value for 30-day all-cause mortality included age, body mass index, hemoglobin, end-stage renal disease, left ventricular ejection fraction, New York Heart Association functional class, extraction for infection, number of prior lead extractions performed by the operator, and extraction of a dual-coil defibrillator lead. These variables were used to create a nomogram with a bootstrap-corrected concordance index value of 0.867. CONCLUSIONS: Thirty-day all-cause mortality after TLE can be assessed with good discriminative power using readily available clinical information.
BACKGROUND: For each clinical circumstance, the benefits of transvenous lead extraction (TLE) need to be weighed against the risks. Clinical decision-making tools for predicting mortality after TLE are lacking. OBJECTIVE: To create a preoperative risk score for prediction of 30-day all-cause mortality after TLE of pacemaker and defibrillator leads. METHODS: Consecutive patients undergoing TLE at the Cleveland Clinic between August 1996 and August 2011 were included in the analysis. A risk nomogram for predicting 30-day all-cause mortality was developed using baseline clinical variables and multivariable logistic regression modeling. Discrimination and calibration were assessed by using bootstrapping for internal validation. Continuous data are presented as median (25th, 75th percentile); categorical data are presented as number (percentage). RESULTS: A total of 5521 (4137 [74.9%] pacemaker and 1384 [25.1%] defibrillator) leads were extracted during 2999 TLE procedures (patient age 67.2 [55.2, 76.2] years, 30.2% female). Lead implant duration was 4.7 (2.4, 8.3) years and 2.0 (1.0, 2.0) leads were extracted per procedure. Sixty-seven patients (2.2%) had died by 30 days after TLE. Variables with the highest predictive value for 30-day all-cause mortality included age, body mass index, hemoglobin, end-stage renal disease, left ventricular ejection fraction, New York Heart Association functional class, extraction for infection, number of prior lead extractions performed by the operator, and extraction of a dual-coil defibrillator lead. These variables were used to create a nomogram with a bootstrap-corrected concordance index value of 0.867. CONCLUSIONS: Thirty-day all-cause mortality after TLE can be assessed with good discriminative power using readily available clinical information.
Authors: Andrzej Kutarski; Wojciech Jacheć; Łukasz Tułecki; Marek Czajkowski; Dorota Nowosielecka; Paweł Stefańczyk; Konrad Tomków; Anna Polewczyk Journal: Sci Rep Date: 2022-06-10 Impact factor: 4.996
Authors: Caleb Norton; Benjamin Holmes; Asad Al Aboud; Eun-Jeong Kim; Holly Gonzales; Christopher Ellis; Roy John; George H Crossley; Jay Montgomery Journal: Case Rep Cardiol Date: 2019-01-03
Authors: Andrzej Ząbek; Krzysztof Boczar; Maciej Dębski; Mateusz Ulman; Roman Pfitzner; Robert Musiał; Jacek Lelakowski; Barbara Małecka Journal: Medicine (Baltimore) Date: 2019-07 Impact factor: 1.817
Authors: Dorota Nowosielecka; Wojciech Jacheć; Anna Polewczyk; Łukasz Tułecki; Konrad Tomków; Paweł Stefańczyk; Andrzej Tomaszewski; Wojciech Brzozowski; Dorota Szcześniak-Stańczyk; Andrzej Kleinrok; Andrzej Kutarski Journal: J Clin Med Date: 2020-05-08 Impact factor: 4.241
Authors: Wojciech Jacheć; Anna Polewczyk; Maciej Polewczyk; Andrzej Tomasik; Andrzej Kutarski Journal: J Clin Med Date: 2020-01-28 Impact factor: 4.241