Among 661 patients with CIED-related infective endocarditis, 59.9% had reimplantation at median 28 days, with no significant difference in recurrent bacteremia or mortality.
Does the timing of CIED reimplantation affect recurrent bacteremia and mortality in patients with CIED-related infective endocarditis treated with lead extraction?
In patients with CIED-related infective endocarditis undergoing extraction, significant variation in reimplantation timing was observed, but timing did not significantly affect recurrent bacteremia or mortality.
Tasa de eventos absoluta: 0% vs 0%
Abstract Background Cardiac implantable electronic device (CIED)-related infective endocarditis (IE) is associated with significant morbidity and mortality. Current guidelines recommend delayed reimplantation after CIED extraction; however, the optimal timing for reimplantation and data on reimplantation practice patterns remain unclear. Purpose In a Danish nationwide study, we evaluated time to reimplantation, associated factors, and outcomes in patients with first-time infective endocarditis and a pre-existing CIED who underwent CIED extraction without heart valve surgery. Methods We included patients aged ≥18 years who were diagnosed with first-time IE (2010–2021), had a CIED, and underwent CIED extraction without heart valve surgery. Only patients with a recorded blood culture were included. We obtained data from Danish nationwide registries. The primary outcome was time to CIED reimplantation within three months after CIED extraction. The secondary outcomes, assessed over six months, were recurrent bacteremia including IE, starting from IE discharge, and all-cause mortality, starting three months post- extraction in survivors. Results The study population comprised 661 patients. The median age of the study population was 74 years (IQR: 66-80 years) and 520 (75.3%) were males. In total, 396 (59.9%) underwent reimplantation within three months after device extraction, with a median time to reimplantation of 28 days (IQR:18.0–35.0 days). A histogram of time from extraction to reimplantation (Figure 1) showed that 62.6% of reimplantations occurred between 3–5 weeks. Before extraction, dual-chamber PMs were more common than single-chamber PMs (178 vs. 58), but after reimplantation, single-chamber PMs became more frequent (132 vs. 102). The median Frailty Risk Score was lower in the reimplantation group compared to the non-reimplantation group (6.7 vs. 7.4; p-value=0.01). In a cause-specific Cox regression analysis, second- and third-degree atrioventricular (HR 1.53, 95% CI: 1.18–1.98), atrial fibrillation (HR 1.32, 95% CI: 1.08–1.63), and age 80 years compared to 70 years (HR 1.34, 95% CI: 1.003–1.78) were significantly associated with higher reimplantation rates. The cumulative incidence of recurrent bacteremia, including IE, was similar between the non-reimplantation and reimplantation group (2.5% 95% CI: 0.95–5.5 vs. 1.8% 95% CI: 0.82–3.6 p=0.55), as was all-cause mortality (10.5% 95% CI: 6.5–15.7 vs. 7.0% 95% CI: 4.7–10.0; p =0.16). There was no significant difference in recurrent bacteremia, including IE, between patients reimplanted within two weeks and those reimplanted later (p-value=0.19). Conclusion Significant variation in timing of reimplantation was observed in this study, without apparent differences in clinical outcomes. These results emphasize the need for further studies on individualized decision-making regarding optimal reimplantation timing in this patient group.
Lafta et al. (Sat,) reported a other. Among 661 patients with CIED-related infective endocarditis, 59.9% had reimplantation at median 28 days, with no significant difference in recurrent bacteremia or mortality.