Highlights
- •No impact of pre-implant clinical characteristics on PM complications' rates in extreme elderly.
- •Elderly comorbidities are predictors of mortality in octogenarians after PM implantation.
- •ACP Score helps to predict short-term mortality risk after PM implantation in extreme elderly.
Abstract
Aims
Significant comorbidities may limit the potential benefit of pacemaker (PM) implantation
in extreme elderly. A short-term mortality risk prediction score, able to identify
high-risk patients, may be a useful tool in this population.
Methods and results
We retrospectively analyzed 538 patients aged >80 years at the time of implant who
underwent PM implantation. Kaplan-Meier survival and multivariable Cox regression
analyses were performed to identify patient, procedural or complication variables
predictive of death. The ACP (Aging in Cardiac Pacing) Score was constructed by assigning
weighted values to the variables identified by hazard ratios, combined into an additive
mortality risk score equation. One, two and three-year overall mortality rate was
11%, 21% and 32% respectively. Renal failure (HR 1.63; CI 1.15–2.31; p = .006), active neoplasia (HR 1.78; CI 1.27–2.51; p = .008), connective tissue disorder (3.07; CI 1.34–7.08; p = .048), cerebrovascular disease (HR 1.75; CI 1.25–2.46; p = .001) and the use of a single lead device (HR 2.27; CI 1.6–3.24; p < .001) were independently associated with worse survival. The ACP Score showed discrete
predictive ability (AUC 0,6792 CI 0,63-0,73). Kaplan-Meier survival curves comparing
low vs high ACP Scores demonstrated that low ACP scores were associated with reduced
mortality rates (p < .001).
Conclusions
Significant comorbidities were associated with worse survival after PM implantation
in extreme elderly. The ACP Score is a novel tool that may help to identify patients
with high mortality risk after device implantation.
Keywords
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Article info
Publication history
Published online: May 13, 2019
Accepted:
April 28,
2019
Received in revised form:
April 26,
2019
Received:
November 1,
2018
Identification
Copyright
© 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
