Lead Extraction and Mortality Among Patients With Cardiac Implanted Electronic Device Infection

Pokorney, Sean D.; Zepel, Lindsay; Greiner, Melissa A.; Fowler, Vance G.; Black-Maier, Eric; Lewis, Robert K.; Hegland, Donald D.; Granger, Christopher B.; Epstein, Laurence M.; Carrillo, Roger G.; Wilkoff, Bruce L.; Hardy, Chantelle; Piccini, Jonathan P.

doi:10.1001/jamacardio.2023.3379

Cited by 12 publications

(2 citation statements)

References 35 publications

(84 reference statements)

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“…Similarly, in a more recent study by Pokorney et al , in 11 304 patients with CIED infection, system extraction was performed within 30 days in only 18.6% of cases. 24 …”

Section: Discussionmentioning

confidence: 99%

Cardiac implantable electronic devices and bloodstream infections: management and outcomes

Özkartal,

Demarchi,

Conte

et al. 2024

European Heart Journal

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Background and Aims Bloodstream infection (BSI) of any cause may lead to device infection in cardiac implantable electronic device (CIED) patients. Aiming for a better understanding of the diagnostic approach, treatment, and outcome, patients with an implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy and defibrillator (CRT-D) hospitalized with BSI were investigated. Methods This is a single-centre, retrospective, cohort analysis including consecutive ICD/CRT-D patients implanted between 2012 and 2021. These patients were screened against a list of all hospitalized patients having positive blood cultures consistent with diagnosed infection in any department of a local public hospital. Results The total cohort consisted of 515 patients. Over a median follow-up of 59 months (interquartile range 31–87 months), there were 47 BSI episodes in 36 patients. The majority of patients with BSI (92%) was admitted to non-cardiology units, and in 25 episodes (53%), no cardiac imaging was performed. Nearly all patients (85%) were treated with short-term antibiotics, whereas chronic antibiotic suppression therapy (n = 4) and system extraction (n = 3) were less frequent. Patients with BSI had a nearly seven-fold higher rate (hazard ratio 6.7, 95% confidence interval 3.9–11.2; P < .001) of all-cause mortality. Conclusions Diagnostic workup of defibrillator patients with BSI admitted to a non-cardiology unit is often insufficient to characterize lead-related endocarditis. The high mortality rate in these patients with BSI may relate to underdiagnosis and consequently late/absence of system removal. Efforts to increase an interdisciplinary approach and greater use of cardiac imaging are necessary for timely diagnosis and adequate treatment.

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“…Similarly, in a more recent study by Pokorney et al , in 11 304 patients with CIED infection, system extraction was performed within 30 days in only 18.6% of cases. 24 …”

Section: Discussionmentioning

confidence: 99%

Cardiac implantable electronic devices and bloodstream infections: management and outcomes

Özkartal,

Demarchi,

Conte

et al. 2024

European Heart Journal

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“…Cardiac implantable electronic device (CIED)-related infections constitute a heterogeneous group of diseases with a poor prognosis. According to recent large studies, in-hospital mortality was 24%, 1-year mortality was 32%, and long-term survival (mean follow-up 5.5 years) was approximately 65% [1][2][3]. The growing number of patients with CIED-related infections is associated with increased hospitalization times and costs and requires more effective strategies to prevent and treat such complications.…”

Section: Introductionmentioning

confidence: 99%

Novel Hematological Parameters in the Assessment of the Extent of Cardiac Implantable Electronic Device-Related Infections

Polewczyk,

Jacheć,

Szczęśniak-Stańczyk

et al. 2023

JCM

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Background: Patients with infectious complications related to the presence of cardiac implantable electronic devices (CIED) constitute a heterogeneous group, ranging from local pocket infection (PI) to lead-related infectious endocarditis (LRIE) infection spreading along the leads to the endocardium. The detection of isolated LRIE and the assessment of the spread of infection in a patient with PI is often difficult and requires complex imaging and microbiological tests. The aim of the current study is to evaluate the usefulness of new simple hematological parameters in detecting infectious complications in patients with CIED, differentiating vegetation and vegetation-like masses, and assessing the extent of infections in patients with PI. Methods: A retrospective analysis of clinical data of 2909 patients (36.37% with CIED-related infections), undergoing transvenous lead extraction (TLE) procedures in three high-volume centres in the years 2006–2020, was conducted. Receiver operating characteristic (ROC) curve analysis was used to assess the sensitivity and specificity of neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-platelet ratio (NPR), and lymphocyte-to-platelet ratio (LPR) in the diagnosis of CIED infections, evaluate the spread of the infectious process in patients with PI and differentiate additional structures related to the presence of lead. Results: The values of NLR and NPR were significantly higher in infectious patients than non-infectious controls (3.07 vs. 2.59; p < 0.001, and 0.02 vs. 0.01; p = 0.008) and the area under the ROC curve (AUC) was 0.59; p < 0.001 and 0.56; p < 0.001, respectively. The high specificity of the new markers in detecting the infectious process was demonstrated: 72.82% for NLR (optimal cut-off value: 3.06) and 79.47% for NPR (optimal cut off value: 0.02). The values of NLR and NPR were significantly higher in patients with vegetations than in non-infectious patients with the presence of additional lead-related masses (3.37 vs. 2.61; p < 0.001 and 0.03 vs. 0.02; p = 0.008). The AUC of NLR and NPR for the prediction of vegetations was 0.65; p < 0.001 and 0.60; p < 0.001 with the highest specificity of NPR (82.78%) and an optimal cut-off value of 0.03. NLR and NPR were higher in patients with LRIE compared to isolated PI (4.11 vs. 2.56; p < 0.001 and 0.03 vs. 0.02; p < 0.001) and the ROC curve analysis for coexistence LRIE with PI showed the AUC for NLR: 0.57; p < 0.001 and AUC for NPR: 0.55; p = 0.001. High specificity in the detection of coexistence between PI and LRIE was demonstrated for NLR (87.33%), with an optimal cut-off value of 3.13. Conclusions: Novel hematological markers (NLR and NPR) are characterized by high specificity in the initial diagnosis of CIED infections, with optimal cut-off values of 3.06 and 0.02. NLR is also useful in the assessment of the spread of infection in patients with PI, with a calculated optimal cut-off value of 3.13. NPR may be helpful in the differentiation of vegetation and vegetation-like masses with an optimal cut-off value of 0.03.

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2024

JAMA Cardiol

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Lead Extraction and Mortality Among Patients With Cardiac Implanted Electronic Device Infection

Cited by 12 publications

References 35 publications

Cardiac implantable electronic devices and bloodstream infections: management and outcomes

Cardiac implantable electronic devices and bloodstream infections: management and outcomes

Novel Hematological Parameters in the Assessment of the Extent of Cardiac Implantable Electronic Device-Related Infections

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