The MB score: a new risk stratification index to predict the need for advanced tools in lead extraction procedures. Issue 4 (22nd February 2020)

• Record Type: Journal Article
• Authors: Bontempi, Luca; Curnis, Antonio; Della Bella, Paolo; Cerini, Manuel; Radinovic, Andrea; Inama, Lorenza; Melillo, Francesco; Salghetti, Francesca; Marzi, Alessandra; Gargaro, Alessio; Giacopelli, Daniele; Mazzone, Patrizio
• Is Part Of: Europace. Volume 22:Issue 4(2020)
• Page Start: 613
• Page End: 621
• Publication Date: 2020-02-22
• Subjects: Cardiac implantable electronic devices -- Lead extraction -- Lead extraction tools -- Implantable cardioverter-defibrillator -- Pacemaker -- MB score; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euaa027
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: A validated risk stratification schema for transvenous lead extraction (TLE) could improve the management of these procedures. We aimed to derive and validate a scoring system to efficiently predict the need for advanced tools to achieve TLE success. Methods and results: Between November 2013 and March 2018, 1960 leads were extracted in 973 consecutive TLE procedures in two national referral sites using a stepwise approach. A procedure was defined as advanced extraction if required the use of powered sheaths and/or snares. The study population was a posteriori 1:1 randomized in derivation and validation cohorts. In the derivation cohort, presence of more than two targeted leads (odds ratio [OR] 1.76, P = 0.049), 3-year-old (OR 3.04, P = 0.001), 5-year-old (OR 3.48, P < 0.001), 10-year-old (OR 3.58, P = 0.008) oldest lead, implantable cardioverter-defibrillator (OR 3.84, P < 0.001), and passive fixation lead (OR 1.91, P = 0.032) were selected by a stepwise procedure and constituted the MB score showing a C-statistics of 0.82. In the validation group, the MB score was significantly associated with the risk of advanced extraction (OR 2.40, 95% confidence interval 2.02-2.86, P < 0.001) and showed an increase in event rate with increasing score. A low value (threshold = 1) ensured 100% sensibility and 100% negative predictive value, while a high value (threshold = 5) allowed a specificity of 92.8% and a positive predictive value of 91.9%. Conclusion: In this study, we developed and tested a simple point-based scoring system able to efficiently identify patients at low and high risk of needing advanced tools during TLE procedures.