Keele Research Repository

Background:
Limited data exist on the impact of comorbidity burden on procedural outcomes after de novo cardiac implantable electronic device (CIED) implantation.

Methods:
De novo CIED implantations in the National Inpatient Sample between 2015 and 2018 were analysed, stratified by Charlson comorbidity index (CCI) score into four comorbidity burden severity categories; CCI-0: none, CCI-1: mild, CCI-2: moderate, CCI-3+: severe. Multivariable logistic regression models were employed to study the association between unit CCI score and in-hospital adverse outcomes.

Results:
A total of 474,475 de novo CIED implantation procedures, the distribution of CCI score was as follows: CCI-0 (17.7%), CCI-1 (21.8%), CCI-2 (18.7%), CCI-3+ (41.8%). There was a positive correlation between CCI score and increased odds ratios (OR) of MACCE (1.10; 95% CI 1.09, 1.11), all-cause mortality (1.23; 95% CI 1.21, 1.25) and acute stroke (1.45; 95% CI 1.44, 1.46). (see Figure 1) A higher CCI score was not associated with increased odds of procedural (thoracic and cardiac) and device-related complications.

Conclusion:
In this national analysis we demonstrate an increased risk of in-hospital mortality and acute ischemic stroke, but not procedure-related (thoracic, cardiac or device-related) complications, with higher comorbidity burden as measured by CCI score. An objective assessment of comorbidity burden using established scores is warranted when risk-stratifying patients undergoing CIED implantation.