August 9, 2017Open Access
View Full PaperPredictors of long-term survival free from relapses after extraction of infected CIED
Key Result
Independent predictors of death or infection relapse after transvenous lead extraction included a closed CIED pocket (HR 2.72), ghosts on echocardiography (HR 3.47), and GFR <60 (HR 4.57).
Study Design
Type
Observational (n=121)
Multicenter
No
Structured PICO
P
Population
121 consecutive patients referred for transvenous lead extraction (TLE) to a teaching hospital to treat a cardiac implantable device related infection (CIEDI) without associated valve-endocarditis.
I
Intervention
Transvenous lead extraction (TLE)
O
Outcome
Composite of death and/or CIEDI relapse/recurrencecomposite
Renal failure, presence of 'ghosts' at post-TLE TEE, and a closed CIED pocket are independent predictors of poor long-term prognosis after transvenous lead extraction for CIED infection.
Main Result
Effect estimate: HR 1.847 (95% CI 1.160-2.941)
p-value: p=0.010
Abstract
Aims: We explored the possible predictors of long-term prognosis after transvenous lead extraction (TLE) for a cardiac implantable device related infection (CIEDI), including the modified Duke score result. Methods and results: We performed a single centre prospective observational study in a population of consecutive patients referred for TLE to a teaching hospital to treat a CIEDI without associated valve-endocarditis. 121 patients were enrolled between January 2012 and March 2016. According to the modified Duke criteria, the presence of CIED-related endocarditis was rejected in 54.5%, possible in 21.5%, and definite in 24.0%. 20/121 patients died after a mean follow-up of 46.0 ± 2.5 months, while 7 patients reported hospitalization for CIEDI recurrence/relapse in the same period. Modified Duke score was significantly associated with a poor prognosis at univariate Cox regression analysis (HR 1.847, 95% CI 1.160-2.941; P = 0.010). However, the three factors independently associated with death and/or CIEDI relapse/recurrence were: a 'closed' CIED pocket (HR 2.720; 95% CI 1.135-6.520), presence of ghost at post-TLE transoesophageal echocardiography (HR 3.469; 95% CI 1.420-8.878), and a GFR <60 (HR 4.565; 95% CI 1.668-12.493). Conclusion: CIEDI has a poor long-term prognosis despite an effective TLE. Renal failure, presence of 'ghosts' at post-TLE transoesophageal echocardiography and a closed CIED pocket are associated with a worse prognosis.