# Pre-Existing Pulmonary Hypertension Impact on In-Hospital Outcomes of Cardiac Implantable Electrical Device Implantation

## TL;DR

Patients with pre-existing pulmonary hypertension face higher risks of complications and mortality during cardiac device implantation procedures.

## Contribution

This study is the first to evaluate the impact of pre-existing pulmonary hypertension on outcomes of cardiac implantable device procedures using a nationwide database.

## Key findings

- Patients with pre-existing PH had a 14.5% complication rate compared to 9.9% in non-PH patients.
- PH was an independent predictor of respiratory complications and in-hospital mortality.
- PH patients were more likely to receive implantable cardioverter defibrillators and cardiac resynchronization therapy devices.

## Abstract

Pre-existing pulmonary hypertension (PH) is associated with unfavorable in-hospital outcomes in cardiac as well as noncardiac surgeries and procedures. However, its impact on cardiac implantable electronic device (CIED) implantations is not established.

The purpose of the study was to investigate the extent of pre-existing PH among patients undergoing CIED implantations and to evaluate its effect on in-hospital outcomes.

Using the National Inpatient Sample database, we identified patients who were hospitalized in the United States between 2016 and 2019 and underwent CIED implantation with a pre-existing diagnosis of PH. Patients with any CIED in situ were excluded. Sociodemographic and clinical data, in-hospital procedures and outcomes, and in-hospital mortality were collected. Multivariable logistic regression models were used to identify predictors of in-hospital complications.

An estimated total of 718,980 patients underwent CIED implantation during the study period. Of them, 74,150 patients (10.3%) had a pre-existing PH diagnosis. Compared with non-PH patients, PH patients were older, had higher Charlson Comorbidity Index, and were more often implanted with implantable cardioverter defibrillators and cardiac resynchronization therapy devices. A higher rate of total complications was observed in PH patients (14.5% vs 9.9%; P < 0.001), driven mainly by respiratory complications as well as in-hospital mortality (2.3% vs 1.2%; P < 0.001). Multivariable analyses confirmed PH as an independent predictor for respiratory complications, total complications, and in-hospital mortality.

Pre-existing PH in patients undergoing CIED implantation was associated with increased risk for respiratory complications as well as in-hospital mortality in a nationwide, all-comer registry.