Routine Inflammation-Haemostasis Panel in Transvenous Lead Extraction: An Exploratory Prospective Single-Centre Cohort Study.

Background/

Objectives

Vascular and bleeding complications drive procedural mortality in transvenous lead extraction (TLE), yet contemporary risk scores include no pre-procedural laboratory measure of haemostasis or inflammation. We evaluated whether a routine inflammation-haemostasis panel (coagulation tests, blood counts and C-reactive protein [CRP]) and peri-procedural matrix metalloproteinase-9 (MMP-9) dynamics predict technical intra-procedural complexity.

Methods

Fifty-four procedures in 53 consecutive patients at a single tertiary centre were analysed prospectively (50% infective; 86 leads). Technical complexity (prolonged procedure or fluoroscopy time; advanced-tool use) was modelled with the number of extracted leads as a predictor rather than an outcome component, in prespecified and stepwise-selected logistic models with bootstrap optimism correction.

Results

The infective indication predicted extraction extent (≥2 leads: 70% vs. 22%) but not technical complexity: the time-based endpoint was not associated with the indication (OR 0.38, p = 0.16), and only cumulative lead dwell time predicted advanced-tool use (OR 1.27 per year; optimism-corrected area under the curve [AUC] 0.72). No routine panel variable predicted any technical endpoint, and none survived multiplicity correction. MMP-9 neither changed peri-procedurally nor differed between indications. A principal-component composite did not improve on CRP alone (AUC 0.66 vs. 0.69; p = 0.67), and the full panel's apparent AUC (0.84) fell to 0.71 after optimism correction.

Conclusions

No routine pre-procedural inflammation-haemostasis variable predicted technical complexity; the infective indication's apparent association reflected guideline-mandated complete system removal-extraction extent-rather than technical difficulty. These exploratory findings support dwell-time- and anatomy-anchored risk scoring, directed haemostasis-activation markers rather than routine screening, and prospective studies capturing bleeding endpoints.