Relation of Prolonged Pacemaker Dependency After Cardiac Surgery to Mortality - 10/12/20
, Fabio Barili, MD, PhD, M. Stat. F.E.S.C. c, Elham Bidar, MD, PhD a, Kevin Vernooy, MD, PhD d, Michele Di Mauro, MD, PhD, MSc. Biostat a, Antonio Miceli, MD, PhD e, Alessandro Parolari, MD, PhD f, Andrea Daprati, MD f, Veronika Myasoedova, MD, PhD f, Francesco Alamanni, MD f, Carlo De Vincentiis, MD g, Ezio Aime’, MD g, Francesco Nicolini, MD, PhD h, GianLuca Gonzi, MD h, Andrea Colli, MD, PhD i, Gino Gerosa, MD i, Michele De Bonis, MD j, Gabriele Paglino, MD, PhD k, Paolo Della Bella, MD k, Guglielmo Actis Dato, MD l, Egidio Varone, MD l, Sandro Sponga, MD, PhD m, Mauro Toniolo, MD n, Alessandro Proclemer, MD n, Ugolino Livi, MD m, Giovanni Mariscalco, MD, PhD o, Marzia Cottini, MD, PhD o, Cesare Beghi, MD o, Roberto Scrofani, MD p, Davide Foresti, MD p, Francesco Paolo Tritto, MD q, Rosario Gregorio, MD q, Emmanuel Villa, MD r, Giovanni Troise, MD r, Domenico Pecora, MD s, Filiberto Serraino, MD, PhD t, Federica Jiritano, MD t, Francesco Rosato, MD u, Elena Grasso, MD v, Domenico Paparella, MD v, Lilla Amorese, MD v, Enrico Vizzardi, MD w, Marco Solinas, MD x, Giuseppe Arena, MD x, Daniele Maselli, MD y, Caterina Simon, MD, PhD z, Mattia Glauber, MD e, Maurizio Merlo, MD zon behalf of the
GIROC Investigators
Highlights |
• | In a retrospective multicenter study, around 1% of the patients require PPI after cardiac surgery. |
• | More than 30% of these patients recover A/V conduction property within months. |
• | Pacemaker dependency is associated with higher mortality. |
• | SR before surgery seems to have a protective effect on pacemaker dependency. |
Résumé |
Permanent pacemaker implantation (PPI) represents a rare complication after cardiac surgery, with no uniform agreement on timing and no information on follow-up. A multicenter retrospective study was designed to assess pacemaker dependency (PMD) and long-term mortality after cardiac surgery procedures. Between 2004 and 2016, PPI-patients from 18 centers were followed. Time-to-event data were evaluated with semiparametric regression Cox models and semiparametric Fine and Gray model for competing risk framework. Of 859 (0.90%) PPI-patients, 30% were pacemaker independent (PMI) at 6 months. PMD showed higher mortality compared with PMI (10-year survival 80.1% ± 2.6% and 92.2% +2.4%, respectively, log-rank p-value < 0.001) with an unadjusted hazard ratio for death of 0.36 (95% CI 0.20 to 0.65, p< 0.001 favoring PMI) and an adjusted hazard ratio of 0.19 (95% CI 0.08 to 0.45, p< 0.001 with PMD as reference). Crude cumulative incidence function of restored PMI rhythm at follow-up at 6 months, 1 year and 12 years were 30.5% (95% CI 27.3% to 33.7%), 33.7% (95% CI 30.4% to 36.9%) and 37.2% (95% CI 33.8% to 40.6%) respectively. PMI was favored by preoperative sinus rhythm with normal conduction (SR) (HR 2.37, 95% CI 1.65 to 3.40, p< 0.001), whereas coronary artery bypass grafting and aortic valve replacement were independently associated with PMD (HR 0.63, 95% CI 0.45 to 0.88, p = 0.006 and HR 0.807, 95% CI 0.65 to 0.99, p = 0.047 respectively). Time-to-implantation was not associated with increased rate of PMI. Although 30% of PPI-patients are PMI after 6 months, PMD is associated with higher mortality at long term.
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| On behalf of the GIROC Investigators. |
|
| Disclosures: The authors have no disclosures. All the authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. |
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| Presented (in part) at the XXIX American Heart Association Annual Meeting. |
Vol 138
P. 66-71 - janvier 2021 Retour au numéro
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