Real-World Evidence on Lead Extraction Following Cardiac Implantable Electronic Device (CIED) Infections and Its Association With 1-year Mortality

Complete lead extraction is strongly recommended for managing cardiac implantable electronic device (CIED) infections. However, actual practices and associated patient outcomes in real-world settings are not well documented. This study aims to quantify use of lead extraction among Australian patients with CIED infections. In this retrospective cohort study, we analyzed linked hospital and mortality data from New South Wales (July 2008 to September 2022). We included patients aged ≥18 years diagnosed with CIED infections, identified using diagnosis codes T82.71 (from July 2017 onwards) and T82.7 with relevant supplementary codes prior to July 2017. We quantified the association between lead extraction and 1-year mortality using time-varying Cox proportional hazards regression models. We included 2,339 patients (mean age 72.5 years, 31.5% female) who were hospitalized with CIED infections, of which 24.0% (n = 561) underwent lead extraction within 30 days. The likelihood of lead extraction was higher among those with sepsis, endocarditis, Staphylococcus aureus infection, prior revision/replacement CIED procedures, and patients admitted to private hospitals. In contrast, older patients (aged 75+ years), female patients, and those with chronic kidney disease were less likely to undergo lead extraction. Lead extraction was associated with reduced 1-year mortality rate (adjusted-HR = 0.64, 95% CI: 0.51 to 0.81), with evidence of greater survival benefit in patients with sepsis and lesser benefit in older patients and females. In conclusion, utilization of lead extraction was limited among patients with CIED infections. Lead extraction was linked to significantly reduced mortality rate, highlighting the importance of improving adherence to recommended management for patients with CIED infections.