Abstract 14216: Predictors of 30-day and 1-year Mortality After Transvenous Lead Extraction for Device Infection

Abstract

Introduction: The incidence of device infection is constantly increasing; requiring transvenous lead extraction (TLE). Data regarding predictors of short and long-term mortality after TLE for infection are limited. Methods: We collected data regarding 30-day and 1-year mortality of patients undergoing TLE at a university hospital between April 2004 and June 2015. Patients with less than 30-day follow up were excluded. Results: Out of total 1223 TLE procedures, 700 were performed for infectious indications. 30-day follow-up was available for 620 patients (88.6%) and 1-year follow up was available for 541 patients (77.3%). Overall 30-day mortality was 9% (4.3% for pocket infection, 12.3% for systemic infection) and 1-year mortality was 27.5% (16% for pocket infection, 35.8% for systemic infection). Patient age, end-stage renal disease, history of valve replacement, atrial fibrillation, Staphylococcus aureus infection, systemic infection, any procedural complication, elevated WBC count, low hemoglobin, need for CCU admission, need for pressor support, acute kidney injury, cardiogenic shock and need for blood transfusion were predictors of both 30-day and 1-year mortality in univariate analysis. Any retained fragment was predictor of 30-day mortality. Peripheral vascular disease and low platelet count were predictors of 1-year mortality. Patient age, history of valve replacement, need for pressor support and low hemoglobin were independent predictors of 30-day as well as 1-year mortality in multivariate analysis. End-stage renal disease, atrial fibrillation, elevated WBC count and need for CCU admission were independent predictors of 30-day mortality. Systemic infection, low platelet count and need for blood transfusion were predictors of 1-year mortality. Strongest predictor of 30-day mortality was history of valve replacement (Odds ratio 4.23) and strongest predictor of 1-year mortality was need for pressor support (Odds ratio 3.12). Conclusions: In conclusion, 30-day and 1-year mortality after device infection remains high despite successful TLE. Patient age, history of valve replacement, need for pressor support and low hemoglobin are independent predictors of both short and long-term mortality in multivariate analysis.