Long-term survival following transvenous lead extraction: unpicking differences according to sex

Vishal S. Mehta; Nadeev Wijesuriya; Felicity DeVere; Sandra Howell; Mark K. Elliott; Nilanka Mannakarra; Tatiana Hamakarim; Steven Niederer; Reza Razavi; Christopher A. Rinaldi

doi:10.1093/europace/euad214

Long-term survival following transvenous lead extraction: unpicking differences according to sex

Vishal S. Mehta^*, Nadeev Wijesuriya, Felicity DeVere, Sandra Howell, Mark K. Elliott, Nilanka Mannakarra, Tatiana Hamakarim, Steven Niederer, Reza Razavi, Christopher A. Rinaldi

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

Abstract

Aims Female sex is a recognized risk factor for procedure-related major complications including in-hospital mortality following transvenous lead extraction (TLE). Long-term outcomes following TLE stratified by sex are unclear. The purpose of this study was to evaluate factors influencing long-term survival in patients undergoing TLE according to sex. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Methods Clinical data from consecutive patients undergoing TLE in the reference centre between 2000 and 2019 were prospectively and results collected. The total cohort was divided into groups based on sex. We evaluated the association of demographic, clinical, device-related, and procedure-related factors on long-term mortality. A total of 1151 patients were included, with mean 66-month follow-up and mortality of 34.2% (n = 392). The majority of patients were male (n = 834, 72.4%) and 312 (37.4%) died. Males were more likely to die on follow-up [hazard ratio (HR) = 1.58 (1.23–2.02), P < 0.001]. Males had a higher mean age at explant (66.2 ± 13.9 vs. 61.3 ± 16.3 years, P < 0.001), greater mean co-morbidity burden (2.14 vs. 1.27, P < 0.001), and lower mean left ventricular ejection fraction (LVEF) (43.4 ± 14.0 vs. 50.8 ± 12.7, P = 0.001). For the female cohort, age > 75 years [HR = 3.45 (1.99–5.96), P < 0.001], estimated glomerular filtration rate < 60 [HR = 1.80 (1.03–3.11), P = 0.037], increasing co-morbidities (HR = 1.29 (1.06–1.56), P = 0.011), and LVEF per percentage increase [HR = 0.97 (0.95–0.99), P = 0.005] were all significant factors predicting mortality. The same factors influenced mortality in the male cohort; however, the HRs were lower. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conclusion Female patients undergoing TLE have more favourable long-term outcomes than males with lower long-term mortality. Similar factors influenced mortality in both groups.

Original language	English
Article number	euad214
Journal	Europace
Volume	25
Issue number	9
DOIs	https://doi.org/10.1093/europace/euad214
Publication status	Published - 1 Sept 2023

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10.1093/europace/euad214

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@article{ea75571b183541de8c834ab998287feb,

title = "Long-term survival following transvenous lead extraction: unpicking differences according to sex",

abstract = "Aims Female sex is a recognized risk factor for procedure-related major complications including in-hospital mortality following transvenous lead extraction (TLE). Long-term outcomes following TLE stratified by sex are unclear. The purpose of this study was to evaluate factors influencing long-term survival in patients undergoing TLE according to sex. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Methods Clinical data from consecutive patients undergoing TLE in the reference centre between 2000 and 2019 were prospectively and results collected. The total cohort was divided into groups based on sex. We evaluated the association of demographic, clinical, device-related, and procedure-related factors on long-term mortality. A total of 1151 patients were included, with mean 66-month follow-up and mortality of 34.2% (n = 392). The majority of patients were male (n = 834, 72.4%) and 312 (37.4%) died. Males were more likely to die on follow-up [hazard ratio (HR) = 1.58 (1.23–2.02), P < 0.001]. Males had a higher mean age at explant (66.2 ± 13.9 vs. 61.3 ± 16.3 years, P < 0.001), greater mean co-morbidity burden (2.14 vs. 1.27, P < 0.001), and lower mean left ventricular ejection fraction (LVEF) (43.4 ± 14.0 vs. 50.8 ± 12.7, P = 0.001). For the female cohort, age > 75 years [HR = 3.45 (1.99–5.96), P < 0.001], estimated glomerular filtration rate < 60 [HR = 1.80 (1.03–3.11), P = 0.037], increasing co-morbidities (HR = 1.29 (1.06–1.56), P = 0.011), and LVEF per percentage increase [HR = 0.97 (0.95–0.99), P = 0.005] were all significant factors predicting mortality. The same factors influenced mortality in the male cohort; however, the HRs were lower. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conclusion Female patients undergoing TLE have more favourable long-term outcomes than males with lower long-term mortality. Similar factors influenced mortality in both groups.",

author = "Mehta, {Vishal S.} and Nadeev Wijesuriya and Felicity DeVere and Sandra Howell and Elliott, {Mark K.} and Nilanka Mannakarra and Tatiana Hamakarim and Steven Niederer and Reza Razavi and Rinaldi, {Christopher A.}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2023.",

year = "2023",

month = sep,

day = "1",

doi = "10.1093/europace/euad214",

language = "English",

volume = "25",

journal = "Europace",

issn = "1099-5129",

publisher = "Oxford University Press (OUP)",

number = "9",

}

TY - JOUR

T1 - Long-term survival following transvenous lead extraction

T2 - unpicking differences according to sex

AU - Mehta, Vishal S.

AU - Wijesuriya, Nadeev

AU - DeVere, Felicity

AU - Howell, Sandra

AU - Elliott, Mark K.

AU - Mannakarra, Nilanka

AU - Hamakarim, Tatiana

AU - Niederer, Steven

AU - Razavi, Reza

AU - Rinaldi, Christopher A.

PY - 2023/9/1

Y1 - 2023/9/1

N2 - Aims Female sex is a recognized risk factor for procedure-related major complications including in-hospital mortality following transvenous lead extraction (TLE). Long-term outcomes following TLE stratified by sex are unclear. The purpose of this study was to evaluate factors influencing long-term survival in patients undergoing TLE according to sex. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Methods Clinical data from consecutive patients undergoing TLE in the reference centre between 2000 and 2019 were prospectively and results collected. The total cohort was divided into groups based on sex. We evaluated the association of demographic, clinical, device-related, and procedure-related factors on long-term mortality. A total of 1151 patients were included, with mean 66-month follow-up and mortality of 34.2% (n = 392). The majority of patients were male (n = 834, 72.4%) and 312 (37.4%) died. Males were more likely to die on follow-up [hazard ratio (HR) = 1.58 (1.23–2.02), P < 0.001]. Males had a higher mean age at explant (66.2 ± 13.9 vs. 61.3 ± 16.3 years, P < 0.001), greater mean co-morbidity burden (2.14 vs. 1.27, P < 0.001), and lower mean left ventricular ejection fraction (LVEF) (43.4 ± 14.0 vs. 50.8 ± 12.7, P = 0.001). For the female cohort, age > 75 years [HR = 3.45 (1.99–5.96), P < 0.001], estimated glomerular filtration rate < 60 [HR = 1.80 (1.03–3.11), P = 0.037], increasing co-morbidities (HR = 1.29 (1.06–1.56), P = 0.011), and LVEF per percentage increase [HR = 0.97 (0.95–0.99), P = 0.005] were all significant factors predicting mortality. The same factors influenced mortality in the male cohort; however, the HRs were lower. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conclusion Female patients undergoing TLE have more favourable long-term outcomes than males with lower long-term mortality. Similar factors influenced mortality in both groups.

AB - Aims Female sex is a recognized risk factor for procedure-related major complications including in-hospital mortality following transvenous lead extraction (TLE). Long-term outcomes following TLE stratified by sex are unclear. The purpose of this study was to evaluate factors influencing long-term survival in patients undergoing TLE according to sex. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Methods Clinical data from consecutive patients undergoing TLE in the reference centre between 2000 and 2019 were prospectively and results collected. The total cohort was divided into groups based on sex. We evaluated the association of demographic, clinical, device-related, and procedure-related factors on long-term mortality. A total of 1151 patients were included, with mean 66-month follow-up and mortality of 34.2% (n = 392). The majority of patients were male (n = 834, 72.4%) and 312 (37.4%) died. Males were more likely to die on follow-up [hazard ratio (HR) = 1.58 (1.23–2.02), P < 0.001]. Males had a higher mean age at explant (66.2 ± 13.9 vs. 61.3 ± 16.3 years, P < 0.001), greater mean co-morbidity burden (2.14 vs. 1.27, P < 0.001), and lower mean left ventricular ejection fraction (LVEF) (43.4 ± 14.0 vs. 50.8 ± 12.7, P = 0.001). For the female cohort, age > 75 years [HR = 3.45 (1.99–5.96), P < 0.001], estimated glomerular filtration rate < 60 [HR = 1.80 (1.03–3.11), P = 0.037], increasing co-morbidities (HR = 1.29 (1.06–1.56), P = 0.011), and LVEF per percentage increase [HR = 0.97 (0.95–0.99), P = 0.005] were all significant factors predicting mortality. The same factors influenced mortality in the male cohort; however, the HRs were lower. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conclusion Female patients undergoing TLE have more favourable long-term outcomes than males with lower long-term mortality. Similar factors influenced mortality in both groups.

UR - http://www.scopus.com/inward/record.url?scp=85167481007&partnerID=8YFLogxK

U2 - 10.1093/europace/euad214

DO - 10.1093/europace/euad214

M3 - Article

C2 - 37466333

AN - SCOPUS:85167481007

SN - 1099-5129

VL - 25

JO - Europace

JF - Europace

IS - 9

M1 - euad214

ER -

Long-term survival following transvenous lead extraction: unpicking differences according to sex

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