Device complications in adult congenital heart disease.
Device complications in adult congenital heart disease.
复制标题
成人先天性心脏病的装置并发症。
DOI：
10.1016/j.hrthm.2014.10.038
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发表时间：
2015
期刊：
影响因子：
5.5
通讯作者：
Tseng,ZianH
中科院分区：
文献类型：
--
作者：
Hayward,RobertM;Dewland,ThomasA;Moyers,Brian;Vittinghoff,Eric;Tanel,RonnE;Marcus,GregoryM;Tseng,ZianH
背景越来越多的成人先天性心脏病患者植入起搏器和植入式心律转复除颤器（ICD），但对植入相关并发症和死亡率知之甚少。方法我们使用健康护理成本和利用项目数据库来识别从2005年1月1日起在加州医院中的初始经静脉起搏器和ICD植入以及植入相关并发症，到2011年12月31日我们计算了植入相关并发症的相对风险，通过比较那些与和那些没有CHD使用泊松回归稳健的标准误，调整年龄和医疗comorbidity.ResultsWe确定了105,852例患者接受起搏器植入，1465与非复杂性CHD和66与复杂性CHD。CHD与起搏器植入相关并发症风险增加无关：校正风险比（aRR）0.92，95%可信区间（CI）0.74- 1.14，P = 0.45。我们确定了32，948例接受ICD植入的患者，其中815例为非复杂性CHD，87例为复杂性CHD。CHD患者ICD植入相关并发症的风险增加：aRR 1.36，95%CI 1.05- 1.76，P = 0.02。复杂冠心病患者ICD植入相关并发症的风险更高：aRR 2.14，95%CI 1.16- 3.95，P = 0.02。在接受设备的患者中，CHD与起搏器（P= 0.07）和ICD（P= 0.19）implantation.ConclusionAmong成年患者接受设备植入在加州，CHD与ICD植入相关并发症的风险增加，但起搏器植入相关并发症或30天住院死亡率较高的趋势。
BackgroundPacemakers and implantable cardioverter-defibrillators (ICDs) are increasingly implanted in adults with congenital heart disease (CHD), but little is known about implant-related complications and mortality.ObjectiveThe purpose of this study was to compare pacemaker and ICD implantation complication rates between adults with and those without CHD using a comprehensive, statewide database.MethodsWe used the Healthcare Cost and Utilization Project database to identify initial transvenous pacemaker and ICD implantations and implant-related complications in California hospitals from January 1, 2005, to December 31, 2011. We calculated relative risks of implant-related complications by comparing those with and those without CHD using Poisson regression with robust standard errors, adjusting for age and medical comorbidities.ResultsWe identified 105,852 patients undergoing pacemaker implantation, 1465 with noncomplex CHD and 66 with complex CHD. CHD was not associated with increased risk of pacemaker implant-related complications: adjusted risk ratio (aRR) 0.92, 95% confidence interval (CI) 0.74–1.14,P= .45. We identified 32,948 patients undergoing ICD implantation, 815 with noncomplex CHD and 87 with complex CHD. Patients with CHD had increased risk of ICD implant-related complications: aRR 1.36, 95% CI 1.05–1.76,P= .02. Patients with complex CHD had greater increased risk of ICD implant-related complications: aRR 2.14, 95% CI 1.16–3.95,P= .02. In patients receiving devices, CHD was associated with a trend toward lower 30-day in-hospital mortality after pacemaker (P= .07) and ICD (P= .19) implantation.ConclusionAmong adult patients undergoing device implantation in California, CHD was associated with increased risk of ICD implant-related complications, but not pacemaker implant-related complications or higher 30-day in-hospital mortality.