Transvenous lead extraction: The influence of age on patient outcomes in the PROMET study cohort.

Abstract

Cardiac implantable electronic device (CIED) therapy contributes to an improvement in morbidity and mortality across all patient demographics. Patient age is a recognized risk factor for unfavorable outcomes in invasive procedures. This is the largest series of non-laser transvenous lead extraction (TLE) evaluating the association between patient age and procedure outcomes. Data of 2205 (3849 leads) patients was collected retrospectively from six European TLE centers between January 2005-December 2018 in the PROMET study. Of these, 153 patients with 319 leads were excluded for incomplete data. A comparison of outcomes was performed between the age groups young [<50 years], young intermediate [50-69 years], older intermediate [70-79 years], and octogenarian [≥80 years]. Infection was most common indication for TLE in the octogenarian cohort, less common in the younger population (60.1%vs. 33.2%, respectively, p<.01). High-voltage leads were extracted most frequently from young patients, less frequently from octogenarians (31.6%vs. 10%, p<.001), while the opposite was evident for pacemaker leads (p<.001). Rotational sheath use was equally prevalent across all patient groups (p=.79). Minor and major complications across all the age groups were statistically similar, as was procedural success; the 30-day mortality was most significant in the octogenarian and least in the young patients (4.9%vs. 0.4%, p=.005). Propensity matching multivariate analysis found systemic infection, lead dwell time, and patient age (p=.013, OR 1.064 [1.013-1.116]) increased risk of 30-day mortality. TLE is safe and effective across all age groups. 30-day mortality risk is significantly higher in the older patients.