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The Impact of Charlson Comorbidity Index on De Novo Cardiac Implantable Electronic Device Procedural Outcomes in the United States

Mohamed, Mohamed O.; Van Spall, Harriette G.C.; Morillo, Carlos; Wilton, Steve B.; Kontopantelis, Evangelos; Rashid, Muhammad; Wu, Pensee; Patwala, Ashish; Mamas, Mamas


Mohamed O. Mohamed

Harriette G.C. Van Spall

Carlos Morillo

Steve B. Wilton

Evangelos Kontopantelis

Ashish Patwala


OBJECTIVE: To investigate the utility of Charlson comorbidity index (CCI) as a measure of comorbidity burden to predict procedural outcomes after de novo cardiac implantable electronic device (CIED) implantation. METHODS: All de novo CIED implantations in the United States National Inpatient Sample between 2015 and 2018 were retrospectively analyzed, stratified by CCI score (0=no comorbidity burden, 1=mild, 2=moderate, =3=severe). Multivariable logistic regression models were performed to examine the association between unit CCI score (scale) and in-hospital outcomes (major adverse cerebrovascular and cardiovascular events [MACCE]: composite of all-cause mortality, acute ischemic stroke, thoracic and cardiac complications, and device-related complications; and MACCE individual components). RESULTS: Of 474,475 CIED procedures, the distribution of CCI score was as follows: CCI=0 (17.7%), CCI=1 (21.8%), CCI=2 (18.7%), and CCI=3+ (41.8%). Charlson comorbidity index score was associated with increased odds ratios of MACCE (1.10; 95% CI, 1.09 to 1.11), all-cause mortality (1.23; 95% CI, 1.21 to 1.25), and acute stroke (1.45; 95% CI, 1.44 to 1.46). This finding was consistent across all CIED groups except the cardiac resynchronization therapy groups in which CCI was not associated with increased risk of mortality. A higher CCI score was not associated with increased odds of procedural (thoracic and cardiac) and device-related complications. CONCLUSION: In a nationwide cohort of CIED procedures, higher comorbidity burden as measured by CCI score was associated with an increased risk of in-hospital mortality and acute ischemic stroke, but not procedure-related (thoracic and cardiac) or device-related complications. Objective assessment of comorbidity burden is important to risk-stratify patients undergoing CIED implantation for better prognostication of their in-hospital survival.

Journal Article Type Article
Acceptance Date Dec 1, 2021
Online Publication Date Dec 1, 2021
Publication Date 2022-01
Journal Mayo Clinic Proceedings
Print ISSN 0025-6196
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 97
Issue 1
Pages 88 - 100
Publisher URL