期刊
EUROPACE
卷 23, 期 9, 页码 1462-1471出版社
OXFORD UNIV PRESS
DOI: 10.1093/europace/euab037
关键词
ELECTRa registry; ELECTRa Registry Outcome Score; Risk stratification; Transvenous lead extraction
资金
- Boston Scientific
- Cook Medical
- Medtronic
- Spectranetics
- Zoll
- Wellcome/EPSRC Centre for Medical Engineering [WT203148/Z/16/Z]
- National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust
- King's College London
The EROS scoring system effectively stratified patients into different risk groups for transvenous lead extraction, with higher EROS scores associated with an increased likelihood of procedural complications requiring urgent surgical intervention.
Aims Transvenous lead extraction is associated with a significant risk of complications and identifying patients at highest risk pre-procedurally will enable interventions to be planned accordingly. We developed the ELECTRa Registry Outcome Score (EROS) and applied it to the ELECTRa registry to determine if it could appropriately risk-stratify patients. Methods and results EROS was devised to risk-stratify patients into low risk (EROS 1), intermediate risk (EROS 2), and high risk (EROS 3). This was applied to the ESC EORP European Lead Extraction ConTRolled ELECTRa registry; 57.5% EROS 1, 31.8% EROS 2, and 10.7% EROS 3. Patients with EROS 3 or 2 were significantly more likely to require powered sheaths and a femoral approach to complete procedures. Patients with EROS 3 were more likely to suffer procedure-related major complications including deaths (5.1 vs. 1.3%; P< 0.0001), both intra-procedural (3.5 vs. 0.8%; P=0.0001) and post-procedural (1.6 vs. 0.5%; P= 0.0192). They were more likely to suffer post-procedural deaths (0.8 vs. 0.2%; P 0.0449), cardiac avulsion or tear (3.8 vs. 0.5%; P < 0.0001), and cardiovascular lesions requiring pericardiocentesis, chest tube, or surgical repair (4.6 vs. 1.0%; P< 0.0001). EROS 3 was associated with procedure-related major complications including deaths [odds ratio (OR) 3.333, 95% confidence interval (CI) 1.879-5.914; P< 0.0001] and alt-cause in-hospital major complications including deaths (OR 2.339, 95% CI 1.4393.803; P= 0.0006). Conclusion EROS successfully identified patients who were at increased risk of significant procedural complications that require urgent surgical intervention.
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