Sex Differences in Periprocedural Safety Outcomes and Mortality Following Cardiac Implantable Electronic Device Transvenous Lead Extraction.

BACKGROUND

Cardiac implantable electronic devices (CIEDs) play a vital role in modern electrophysiology but are prone to complications, necessitating transvenous lead extraction (TLE) in certain cases. Recent studies suggest sex-based disparities in cardiovascular outcomes, yet little is known about sex differences in TLE complications.

OBJECTIVE

This study aimed to evaluate sex-related differences in peri-procedural outcomes following TLE.

METHODS

We conducted a retrospective, observational cohort study using the National Inpatient Sample (NIS) from 2016 to 2019. Patients undergoing TLE due to CIED-related issues were identified using ICD-10 codes. Exclusions included patients with concurrent cardiac surgeries or incomplete outcome data. Propensity score matching (1:1) was used to balance demographic and clinical variables between sexes. Multivariate and univariate logistic regression analyses were performed to assess outcomes, with statistical significance set at p < 0.05.

RESULTS

The final matched cohort included 20 970 admissions (10 480 men; 10 490 women). No significant sex-based difference in in-hospital mortality was observed (OR: 1.12, p = 0.184). However, women exhibited increased risks for cardiac complications (OR: 1.24) and pulmonary complications (OR: 1.21), including higher rates of pericardial effusion, tamponade, pneumothorax, and hemothorax. Men showed a higher incidence of vascular complications (OR: 0.76).

CONCLUSIONS

Despite similar in-hospital mortality, women patients undergoing TLE experienced significantly higher rates of cardiac and pulmonary complications compared to men. These findings highlight the need for sex-specific risk assessment and procedural planning to improve safety and outcomes in TLE.