Incidence, Treatment, and Outcomes of Symptomatic Device Lead-Related Venous Obstruction.
Incidence, Treatment, and Outcomes of Symptomatic Device Lead-Related Venous Obstruction.
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DOI：
10.1016/j.jacc.2023.04.017
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发表时间：
2023-06-20
影响因子：
24
通讯作者：
Secemsky, Eric A.
中科院分区：
文献类型：
--
作者：
Ferro, Enrico G.;Kramer, Daniel B.;Li, Siling;Locke, Andrew H.;Misra, Shantum;Schmaier, Alec A.;Carroll, Brett J.;Song, Yang;'Avila, Andre A. D.;Yeh, Robert W.;Zimetbaum, Peter J.;Secemsky, Eric A.
关键词：
植入心血管植入式电子器械（CIED）的患者中电极导线相关静脉阻塞（LRVO）的发生率和临床影响尚不明确。本研究的目的是确定CIED植入后症状性LRVO的发生率;描述CIED取出和血运重建的模式;并根据每种类型的干预措施量化LRVO相关的医疗保健利用。LRVO状态是在2015年10月1日至2020年12月31日植入CIED后在Medicare受益人中定义的。用Fine-Gray方法估计LRVO的累积发病率函数。使用考克斯回归确定LRVO预测因子。使用泊松模型计算LRVO相关医疗保健访视的发生率。在接受CIED植入的649，524例患者中，28，214例发生LRVO，最长随访5.2年时的累积发生率为5.0%。LRVO的独立预测因素包括> 1导联的CIED（HR：1.09; 95% CI：1.07 - 1.15）、慢性肾脏疾病（HR：1.17; 95% CI：1.14 - 1.20）和恶性肿瘤（HR：1.23; 95% CI：1.20 - 1.27）。大多数LRVO患者（85.2%）采用保守治疗。在4,186例（14.8%）接受介入治疗的患者中，74.0%接受了CIED取出术，26.0%接受了经皮血运重建术。值得注意的是，90%的患者在拔除后没有接受另一次CIED，无导线起搏器的使用率较低（2.2%）。在调整后的模型中，与保守治疗相比，拔牙与LRVO相关的医疗保健利用率显著降低相关（调整率比：0.58; 95%CI：0.52 - 0.66）。在全国范围内的大样本中，LRVO的发病率很高，每20例CIED患者中就有1例受影响。器械拔除是最常见的干预措施，与复发性医疗保健利用的长期减少相关。
The incidence and clinical impact of lead-related venous obstruction (LRVO) among patients with cardiovascular implantable electronic devices (CIEDs) is poorly defined. The objectives of this study were to determine the incidence of symptomatic LRVO after CIED implant; describe patterns in CIED extraction and revascularization; and quantify LRVO-related health care utilization based on each type of intervention. LRVO status was defined among Medicare beneficiaries after CIED implant from October 1, 2015, to December 31, 2020. Cumulative incidence functions of LRVO were estimated by Fine-Gray methods. LRVO predictors were identified using Cox regression. Incidence rates for LRVO-related health care visits were calculated with Poisson models. Among 649,524 patients who underwent CIED implant, 28,214 developed LRVO, with 5.0% cumulative incidence at maximum follow-up of 5.2 years. Independent predictors of LRVO included CIEDs with >1 lead (HR: 1.09; 95% CI: 1.07-1.15), chronic kidney disease (HR: 1.17; 95% CI: 1.14-1.20), and malignancies (HR: 1.23; 95% CI: 1.20-1.27). Most patients with LRVO (85.2%) were managed conservatively. Among 4,186 (14.8%) patients undergoing intervention, 74.0% underwent CIED extraction and 26.0% percutaneous revascularization. Notably, 90% of the patients did not receive another CIED after extraction, with low use (2.2%) of leadless pacemakers. In adjusted models, extraction was associated with significant reductions in LRVO-related health care utilization (adjusted rate ratio: 0.58; 95% CI: 0.52-0.66) compared with conservative management. In a large nationwide sample, the incidence of LRVO was substantial, affecting 1 of every 20 patients with CIEDs. Device extraction was the most common intervention and was associated with long-term reduction in recurrent health care utilization.
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