Prognosis after pacemaker implantation in extreme elderly

Aims: Significant comorbidities may limit the potential benefit of pacemaker (PM) implantation in extreme elderly. A short-term mortality risk prediction score, able to identify high-risk patients, may be a useful tool in this population. Methods and results: We retrospectively analyzed 538 patients aged >80 years at the time of implant who underwent PM implantation. Kaplan-Meier survival and multivariable Cox regression analyses were performed to identify patient, procedural or complication variables predictive of death. The ACP (Aging in Cardiac Pacing) Score was constructed by assigning weighted values to the variables identified by hazard ratios, combined into an additive mortality risk score equation. One, two and three-year overall mortality rate was 11%, 21% and 32% respectively. Renal failure (HR 1.63; CI 1.15–2.31; p =.006), active neoplasia (HR 1.78; CI 1.27–2.51; p =.008), connective tissue disorder (3.07; CI 1.34–7.08; p =.048), cerebrovascular disease (HR 1.75; CI 1.25–2.46; p =.001) and the use of a single lead device (HR 2.27; CI 1.6–3.24; p <.001) were independently associated with worse survival. The ACP Score showed discrete predictive ability (AUC 0,6792 CI 0,63-0,73). Kaplan-Meier survival curves comparing low vs high ACP Scores demonstrated that low ACP scores were associated with reduced mortality rates (p <.001). Conclusions: Significant comorbidities were associated with worse survival after PM implantation in extreme elderly. The ACP Score is a novel tool that may help to identify patients with high mortality risk after device implantation.