Igor Diemberger1, Federico Migliore2, Mauro Biffi3, Alberto Cipriani2, Emanuele Bertaglia2, Stefano Lorenzetti3, Giulia Massaro3, Gaia Tanzarella3, Giuseppe Boriani4. 1. Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy. Electronic address: igor.diemberger@unibo.it. 2. Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy. 3. Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy. 4. Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy; Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
Abstract
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.
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.
Authors: Dorota Nowosielecka; Wojciech Jacheć; Anna Polewczyk; Łukasz Tułecki; Andrzej Kleinrok; Andrzej Kutarski Journal: Int J Environ Res Public Health Date: 2021-02-14 Impact factor: 3.390