Abstract 12524: A Novel Scoring Index Predicts 6-Month Infection Risk Following ICD or CRT-D Device Implantation
Background: Infection following device implantation is associated with morbidity and mortality. Although several risk factors have been identified, the quantifiable risk in any patient (pt) is likely dependent on a specific combination of factors. This study sought to develop a scoring index to stratify the 6-month infection risk following ICD or CRT-D implantation.
Methods: We identified 647 consecutive pts who underwent an ICD or CRT-D procedure and all pts who suffered a major infection (removal of all hardware) within 6-mos of the procedure. A logistic regression model for infection was developed and the adjusted odds ratio for significant factors was used to create a 25-point risk score that was partitioned to create 3 risk groups (0-7; 8-14; 15-25 points).
Results: Of the 647 pts, 505 (78%) were male, 400 (62%) had an ICD, and 247 (38%) had a CRT-D. Procedures were de novo in 387 (60%), generator change in 185 (29%), device upgrade in 62 (9%) and early pocket re-exploration in 12 (2%) pts. Infection occurred in 19 (2.9%) pts. We identified 7 risk factors for infection; each carried a substantially varied level of risk (see Figure). Pts with a composite risk score of 0-7 had a 1% infection rate while those with a score of 15-25 had much greater risk, 11.1% (p=0.009; Figure).
Conclusions: The simple presence of risk factors alone cannot identify pts at risk for infection following ICD or CRT-D implantation. Risk is critically dependent on the particular combination of risk factors. This novel scoring index, derived from readily availably clinical variables, can be used to stratify pts at low, medium and high-risk of infection following their device procedure.
- © 2013 by American Heart Association, Inc.