Cardiac Device Infections: A Lesson from the Registries

Barletta, V; Morolla, Davide; Tommasina, Veronica Della; Segreti, Luca; Cori, A Di; Zucchelli, Giulio; Bongiorni, Maria Grazia

doi:10.1007/978-3-030-46255-0_4

Cited by 1 publication

(2 citation statements)

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“…At the same time, ELECTRa was not a registry focusing on CIEDI but on TLE with the possible bias of leaving unexplored patients who were not candidates to TLE. For this reason, it did not consider diagnostic procedures like PET/CT scans [26]. However, TLE is the current standard of care of CIEDI and ELECTRa provide prospective data on currently treated candidates to TLE, which underlines the relevance of our results.…”

Section: Limitationsmentioning

confidence: 95%

“…Finally, as previously acknowledged the distinction between Sy-CIEDI and Lo-CIEDI in a specific patient was mainly based on the interpretation the complete clinical picture by each investigator, leading to the possibility of misclassification. However, this approach reflects the current clinical practice and the limitation in univocally defining local vs. systemic CIEDI [8,26,27].…”

Section: Limitationsmentioning

confidence: 99%

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Transvenous Lead Extraction in Patients with Cardiac Implantable Device: The Impact of Systemic and Local Infection on Clinical Outcomes—An ESC-EHRA ELECTRa (European Lead Extraction Controlled) Registry Substudy

Diemberger

Segreti

Rinaldi

et al. 2022

Biology

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Background: Infections of cardiac implantable devices (CIEDI) have poor outcomes despite improvement in lead extraction (TLE) procedures. Methods: To explore the influence of CIEDI on the outcomes of TLE and the differences between patients with systemic (Sy) vs. local (Lo) CIEDI, we performed a sub-analysis of the EORP ELECTRa (European Lead Extraction ConTRolled) Registry. Results: Among 3555 patients enrolled by 73 centers in 19 Countries, the indication for TLE was CIEDI in 1850: 1170 with Lo-CIEDI and 680 with Sy-CIEDI. Patients with CIEDI had a worse in-hospital prognosis in terms of major complications (3.57% vs. 1.71%; p = 0.0007) and mortality (2.27% vs. 0.49%; p < 0.0001). Sy-CIEDI was an independent predictor of in-hospital death (H.R. 2.14; 95%CI 1.06–4.33. p = 0.0345). Patients with Sy-CIEDI more frequently had an initial CIED implant and a higher prevalence of comorbidities, while subjects with Lo-CIEDI had a higher prevalence of previous CIED procedures. Time from signs of CIEDI and TLE was longer for Lo-CIEDI despite a shorter pre-TLE antibiotic treatment. Conclusions: Patients with CIEDI have a worse in-hospital prognosis after TLE, especially for patients with Sy-CIEDI. These results raise the suspicion that in a relevant group of patients CIEDI can be systemic from the beginning without progression from Lo-CIEDI. Future research is needed to characterize this subgroup of patients.

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Section: Limitationsmentioning

confidence: 95%

Section: Limitationsmentioning

confidence: 99%