Predictors of Complications

Most factors discussed above can influence the incidence of complications in transvenous extraction procedures. Regardless of technique and tools used, transvenous extraction is affected by a significant risk of serious complications, including fatal events. Many conditions may be managed by the experienced operator and by training to immedi- 

Major complications are statistically more frequent in the female gender. The possible explanation of this observation is that in women, particularly the elderly, the venous and myocardial walls are more fragile than in men. The smaller vein size 

Regardless of procedural complications, it must be emphasized that patients affected by systemic infection related to an implantable cardiac device are at high risk because of the infective disease and overwhelming sepsis. Hamid and colleagues [67] recently reported their experience with 183 patients referred for transvenous lead extraction. The incidence of death due to sepsis was as high as 2.7% predictor of unfavorable outcome was a significant increase in inflammatory markers. 

Byrd CL, Schwartz SJ, Hedin NB et al (1990) Intravascular lead extraction using locking stylets and sheaths. Pacing Clin Electrophysiol 13 1871-1875 

Love CJ, Wilkoff BL, Byrd CL et al (2000) Recommendations for extraction of chronically implanted transvenous pacing and defibrillator leads indications, facilities, training. North American Society of Pacing and Electrophysiology Lead Extraction Conference Faculty. Pacing Clin Electrophysiol 23(4 Pt 1) 544-551 

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Agarwal SK, Kamireddy S, Nemec J et al (2009) Predictors of complications of endovascular chronic lead extractions from pacemakers and defibrillators a single-operator experience. J Cardiovasc Electrophysiol 20(2) 171-175... 

Valente S, Lazzeri C, Crudeli E, et al. Intraaortic balloon piunp incidence and predictors of complications in the Rorence registry. Clin Cardiol April 2012 35(4) 200-4. 

The Italian study subanalysis identifies as independent predictors of VTE age > 60 years, height > 165 cm, and diastolic blood pressure > 90 mm. Also relevant is the association between high global cardiovascular risk scores and VTE incidence. This means that there is a correlation between arterial and venous risks, and consequently prevention of arterial complications will also mean lower venous risk (Decensi et al. 2005 Goldhaber 2005) (Fig. 10.9). 

Finally, as noted earlier, comorbid substance abuse, particularly with bipolar male patients, is a strong predictor of suicide-related lethality. It is critically important to recognize these complicating disorders and aggressively intervene with appropriate clinical strategies. Referral to Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and other related counseling support programs, as well as prescription of naltrexone (Revia) in the appropriate patients, may also help to diminish the risk of serious morbidity (see also the section The Alcoholic Patient in Chapter 14). 

Mathur A, Roubin GS, Iyer SS, et al. Predictors of stroke complicating carotid artery stenting. Circulation 1998 97 1239-1245. 

Index functional status 30 d after stroke. The results showed that only the severity of neurological deficit predicted greater 30-d mortality in these patients. Patients with hyperthermia on the first day of hospitalization had increased mortality and worse functional status at 30 d, but increased temperature was not an independent predictor of mortality 30 d after PICH. In a study to assess typical early onset complications following ischemic stroke, Weimar et al. (5) looked at a cohort of 3866 patients from 14 neurology departments with an acute stroke unit. In the first week following admission, increased intracranial pressure (ICP) and recurrent cerebral ischemia were the most frequent complications, along with fever, severe hypertension, and pneumonia. Similar concerns are also found in cardiac surgery patients in whom perioperative stroke occurred (6). 

A better predictor of RDS, especially in complicated cases, such as diabetes, is phosphatidylglyceride (PG) phosphatidic acid esterified with glycerol at its phosphate residue. An amniotic fluid PG level of less than 0.5 /ug/mL predicts RDS after birth. 

It is important to understand that electronegativity is not a measurable property of an atom in the sense that ionization energies and electron affinities are, although it can be correlated with both of these properties. The actual electron-attracting power of an atom depends in part on its chemical environment (that is, on what other atoms are bonded to it), so tabulated electronegativities should be regarded as high-precision predictors of the behavior of electrons in more complicated molecules. 

Monnier VM, Sell DR, Genuth S. Glycation products as markers and predictors of the progression of diabetic complications. Ann. N. Y. Acad. Sci. 2005 1043 567-581. 

Proximal renal tubnlar proteinuria is a possible complication in patients treated with high doses of mesalazine, and it is clearly important to monitor renal function in these patients (SEDA-22, 394) (75). Two studies in 21 (76) and 95 (77) patients with ulcerative colitis and Crohn s disease have shown that proteinuria of tubular marker proteins is common and is related to disease activity rather than to treatment with mesalazine. Thus, tubular proteins are not useful predictors of an adverse renal response to the drug. Nephrotic syndrome with minimal change nephropathy has been described with sulfasalazine and mesalazine (SEDA-16, 427). 

Edema is a relatively frequent finding in normal pregnancy. It appears to be benign and can even be associated with improved obstetric performance (139). Edema, even in the presence of hypertension or proteinuria, is not a useful predictor of obstetric complications (140). These observations are important, in view of the finding that treatment with thiazide diuretics is associated with a reduced birth weight in normotensive pregnant subjects (141). 

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