The "Subtle" connection between development of cardiac implantable electrical device infection and survival after complete system removal: An observational prospective multicenter study.
BACKGROUND
Despite the improvements in transvenous lead extraction (TLE), patients with cardiac implantable device related infection (CIEDI) have a poor prognosis at long term. We explored the possible role of factors associated with development of CIEDI as predictors of post-TLE survival.


METHODS
We performed a multi-center prospective observational study in a population of consecutive patients referred for TLE for CIEDI. We adopted a previously developed 10-point scale for CIEDI risk stratification and assessed its performance in predicting post-TLE survival.


RESULTS
We enrolled 169 consecutive patients with CIEDI (systemic infection in 48.5% and vegetations in 24.5%). A Shariff score ≥3 was present in 102/169 (60.4%) of the enrolled patients. Complete radiological success of TLE was obtained in 163 patients. Twenty-seven patients (15.9%) died after a mean follow-up of 20.8±12.0months. Two factors were independently associated with post-TLE death: a Shariff score ≥3 (HR 10.833, 95% CI 2.544-46.129; p=0.001) and the presence of vegetations at transesophageal echocardiography (HR 3.324, 95% CI 1.530-7.221; p=0.002).


CONCLUSIONS
Risk factors for development of CIEDI are also predictive of post TLE mortality, together with the presence of vegetations. Improvement of our preventive strategies for CIEDI is crucial for enhancing the outcomes of CIED patients overall.
['Diemberger|Igor|I|', 'Migliore|Federico|F|', 'Biffi|Mauro|M|', 'Cipriani|Alberto|A|', 'Bertaglia|Emanuele|E|', 'Lorenzetti|Stefano|S|', 'Massaro|Giulia|G|', 'Tanzarella|Gaia|G|', 'Boriani|Giuseppe|G|']
D000368:Aged D000369:Aged, 80 and over D017147:Defibrillators, Implantable D020878:Device Removal D004567:Electrodes, Implanted D004697:Endocarditis, Bacterial D005260:Female D005500:Follow-Up Studies D006801:Humans D008297:Male D008875:Middle Aged D011446:Prospective Studies D016459:Prosthesis-Related Infections D012307:Risk Factors D015996:Survival Rate
Infection Lead extraction Vegetation Defibrillator Endocarditis Pacemaker