POST-HOC STRATIFICATION OF THE RISK OF INFECTION IN EXTRACTED PATIENTS

Abstract

Abstract Introduction Infection represents one of the most widespread and feared complications of CIED implantation procedures. Most of the time this could even evolve into endocarditis on electrocatheters or septic shock, to the point that the only life-saving therapy becomes the transvenous extraction of electrocatheters. For this reason, the problem often arises of preventing these infectious conditions by carrying out an infectious risk assessment before the implant so as not to incur these complications over time. This study aims to stratify post-hoc the infectious risk of patients extracted in our center to validate the introduction and use of scores for the pre-implantation assessment of infectious risk. Methodology We evaluated 163 patients who underwent transvenous extraction of leads, of which 130 due to pocket infection/endocarditis on leads or sepsis. In these patients, a post-hoc assessment of the risk of infection was made according to the UPCM score, a score created by the University of Pittsburgh. A score value greater than or equal to 7 identifies patients who are more likely to develop an infection over time. This score takes into account risk factors such as: early reoperation, type of device implanted (CRTD vs ICD/PM), presence of more than 2 catheters in place, replacement or revision of the device, use of temporary pacing, intake of corticosteroids or anticoagulants oral, renal function, fever within 24 hours before implantation, presence of diabetes or heart failure, male gender. We then paid particular attention to patients who had undergone an upgrade procedure or to those who had undergone an extraction procedure twice. Results Of the 130 patients in our center who underwent extraction for infection, 112 had a score greater than or equal to 7; On the other hand, 18 were those with a score lower than 7. The average value was found to be 22.9. Conclusions The identification of a score that can be evaluated before the CIED implantation procedure can be an excellent aid in identifying fragile patients who could suffer from infection in the long or short term. By doing this, further alternatives to the transvenous implant could be evaluated, such as the implantation of a leadless pacemaker or subcutaneous ICD in non-PM dependent patients eligible for this.