Abstract 11441: Long Term Mortality Among Patients Undergoing Extraction of Infected Cardiac Implantable Electronic Devices is Significant and Could be Related to the Type of Infection
Background: Infections of Cardiovascular Implantable Electronic Devices (CIEDs) are infrequent, but given the increasing indications for these devices, the impact of this outcome is expected to remain substantial. The data about long-term mortality of these patients are limited. Hypothesis: We assessed the hypothesis that long term mortality among patients undergoing extraction of an infected CIED is high and could be related to the type of infection.
Methods: We reviewed the medical records of all patients with infected CIEDs referred to the Cleveland Clinic who underwent extraction of the device in the electrophysiology lab from 2002 to 2007.
Results: A total of 431 patients (mean age 68±15 years) were included in the study. The majority (323, 75%) were male. The majority of patients (253, 59%) presented with localized infection involving the device pocket (pocket infection group). The remaining 178 patients (41%) presented with endovascular infection but no evidence of inflammation of the device pocket (endovascular infection group). All patients underwent removal of the CIED and leads. In-hospital morality was 4.6% (20 patients) and only 2 of these deaths were extraction related. One year and three year mortalities were (12%) and (27%) respectively in the pocket infection group, and (28%) and (43%) respectively in the endovascular infection group. After adjusting using multivariable Cox regression model, risk factors for one year mortality included age, renal failure, lower ejection fraction, worse NYHA functional class and endovascular infection presentation (Table).
Conclusion: CIED infections are infrequent, but carry significant short and long-term mortality. Mortality risk factors include age, advanced cardiomyopathy, renal failure and infection type (Endovascular infection).
- © 2011 by American Heart Association, Inc.