Predictors of long-term mortality after transvenous lead extraction of an infected cardiac device: a risk prediction model for sustainable care delivery.

Background and aims : Transvenous lead extraction (TLE) has become a pivotal part of a comprehensive lead management strategy, dealing with a continuously increasing demand. Nonetheless, literature about the long-term impact of TLE on survivals still lacking. Given these knowledge gaps, the aim of our study was to analyse very long-term mortality in patients undergoing TLE in public health perspective. Methods : This prospective, single-centre, observational study enrolled consecutive patients with cardiac implantable electronic device (CIED) who underwent TLE, from January 2005 to January 2021. The main goal was to establish the independent predictors of very long-term mortality after TLE. We also aimed at assessing procedural and hospitalization related costs. Results : We enrolled 435 patients (mean age 70 ± 12 years, with mean lead dwelling time 6.8 ± 16.7 years), with prevalent infective indication to TLE (92%). Initial success of TLE was achieved in 98% of population. After a median follow-up of 4.5 years (range 1 month- 15.5 years),150 of the 435enrolled patients (34%) died. At multivariate analysis, death was predicted by: age (≥ 77 years, OR: 2.55, CI: 1.8-3.6, p<0.001), chronic kidney disease (CKD)defined as severe reduction of estimated glomerular filtration rate (eGFR <30 mL/min/1.73m2, OR:1.75, CI: 1.24-2.4, p=0.001), systolic dysfunction assessed before TLE defined as left ventricular ejection fraction (LVEF) <40%, OR:1.78, CI 1.26-2.5, p=0.001). Mean extraction and reimplantation-related costs were 5989 per procedure. Conclusions : Our study identified three predictors of long-term mortality in a high-risk cohort of patients with a cardiac device infection, undergoing successful TLE. The future development of a mortality risk score before might impact on public health strategy.