Abstract
Cardiac implantable electronic device (CIED) infections are associated with a high mortality. Our aim was to identify key predictors of survival in patients with CIED infections as to be able to detect high-risk patients and possibly affect modifiable factors. In this observational study, we collected data from 277 patients with CIED infections treated in our department between 2001 and 2017; predictors of survival were evaluated. The median time since the last CIED procedure was 0.83 years (interquartile range [IQR]: 0.25-3.01), median time since initial CIED implant was 4.79 years (IQR: 0.90-11.0 years). Survival at 30 days was 94.9% (95% confidence interval [CI]: 92.3-97.5) and survival at 1 year was 80.9% (CI: 76.4-85.7). Age (odds ratio [OR]: 1.05, CI: 1.01-1.09; P = .009), end stage renal disease (ESRD) with dialysis (OR: 5.14, CI: 1.87-14.11; P = .001), positive blood cultures (OR: 2.19, CI: 1.08-4.45; P = .030), and thrombocytopenia (OR: 2.3, CI, 1.03-5.15; P = .042) were identified as predictors of death within 1 year of treatment of CIED infection. Patients with CIED infection with prior ESRD with dialysis or preoperative thrombocytopenia are at an increased risk of 1-year mortality. We suggest that these patients be evaluated critically and resources be allocated to these patients more liberally. A greater understanding of the role of platelets in immunity may improve treatment of advanced infection in the future.
Highlights
Cardiac implantable electronic device (CIED) infections are associated with a high mortality rate[1] and high treatment costs.[2]
Our cohort consists of 277 patients with CIED infections; 148 patients (53.4%) with CIEDR‐IE and 129 (46.6%) with isolated pocket infections (IPI)
Multivariable analysis of predictors of 1‐year mortality suggests that patient age, end state renal disease (ESRD) with dialysis, positive blood cultures, and thrombocytopenia are key predictors
Summary
Cardiac implantable electronic device (CIED) infections are associated with a high mortality. Conclusion: Patients with CIED infection with prior ESRD with dialysis or preoperative thrombocytopenia are at an increased risk of 1‐year mortality. We suggest that these patients be evaluated critically and resources be allocated to these patients more liberally. CIED infections constituting the most critical complication of CIED therapy, it is key that this entity be understood to the fullest To this end the authors of the 2018 EHRA consensus statement on lead extraction made a point of mentioning that there are several gaps in evidence and that further research is required.[3].
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