title: Nomogram for predicting 30-day all-cause mortality after transvenous pacemaker and defibrillator lead extraction.
abstract: BACKGROUND
  For each clinical circumstance, the benefits of transvenous lead extraction (TLE) need to be weighed against the risks. Clinical decision-making tools for predicting mortality after TLE are lacking.
  
  
  OBJECTIVE
  To create a preoperative risk score for prediction of 30-day all-cause mortality after TLE of pacemaker and defibrillator leads.
  
  
  METHODS
  Consecutive patients undergoing TLE at the Cleveland Clinic between August 1996 and August 2011 were included in the analysis. A risk nomogram for predicting 30-day all-cause mortality was developed using baseline clinical variables and multivariable logistic regression modeling. Discrimination and calibration were assessed by using bootstrapping for internal validation. Continuous data are presented as median (25th, 75th percentile); categorical data are presented as number (percentage).
  
  
  RESULTS
  A total of 5521 (4137 [74.9%] pacemaker and 1384 [25.1%] defibrillator) leads were extracted during 2999 TLE procedures (patient age 67.2 [55.2, 76.2] years, 30.2% female). Lead implant duration was 4.7 (2.4, 8.3) years and 2.0 (1.0, 2.0) leads were extracted per procedure. Sixty-seven patients (2.2%) had died by 30 days after TLE. Variables with the highest predictive value for 30-day all-cause mortality included age, body mass index, hemoglobin, end-stage renal disease, left ventricular ejection fraction, New York Heart Association functional class, extraction for infection, number of prior lead extractions performed by the operator, and extraction of a dual-coil defibrillator lead. These variables were used to create a nomogram with a bootstrap-corrected concordance index value of 0.867.
  
  
  CONCLUSIONS
  Thirty-day all-cause mortality after TLE can be assessed with good discriminative power using readily available clinical information.
authors.affiliation: Departments of Cardiac Pacing and Electrophysiology.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Brunner
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Changhong
authors.initials: C
authors.lastname: Yu
authors.affiliation: Departments of Cardiac Pacing and Electrophysiology.
authors.forename: Ayman A
authors.initials: AA
authors.lastname: Hussein
authors.affiliation: Departments of Cardiac Pacing and Electrophysiology.
authors.forename: Khaldoun G
authors.initials: KG
authors.lastname: Tarakji
authors.affiliation: Departments of Cardiac Pacing and Electrophysiology.
authors.forename: Oussama M
authors.initials: OM
authors.lastname: Wazni
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.affiliation: Departments of Cardiac Pacing and Electrophysiology. Electronic address: wilkofb@ccf.org.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Wilkoff
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000401:mortality* / Q000628:therapy*; D000066491:Clinical Decision-Making; D017147:Defibrillators, Implantable; D020878:Device Removal / Q000401:mortality*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D010138:Pacemaker, Artificial; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
keywords: Extraction; Implantable cardioverter-defibrillator; Lead; Nomogram; Pacemaker; Risk score