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Risk factors for mortality in patients with cardiac device-related infection

Timir S Baman1, Sanjaya K Gupta, Javier A Valle

  • 1Department of Cardiology, University of Michigan, Ann Arbor, Michigan, USA.

Circulation. Arrhythmia and Electrophysiology
|October 8, 2009
PubMed

Insights

Cardiac device infections increase mortality risk. Systemic embolization, tricuspid regurgitation, and abnormal heart or kidney function predict death in these patients. Early identification is key.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Devices

Background:

  • Cardiac device infections pose significant morbidity and mortality risks.
  • Limited data exists on mortality risk factors in patients with cardiac-device related infections.
  • Increased use of pacemakers and implantable cardioverter defibrillators contributes to this challenge.

Purpose of the Study:

  • To evaluate prognostic significance of clinical and echocardiographic variables in cardiac-device related infections.
  • To identify risk factors for mortality in patients with cardiac device infections.
  • To inform more aggressive evaluation strategies for high-risk patients.

Main Methods:

  • Retrospective analysis of 210 patients with cardiac-device related infection (1995-2006).
  • Data abstracted on clinical, echocardiographic variables, treatment, and 6-month outcomes.
  • Multivariable Cox proportional hazards models used to assess mortality predictors.

Main Results:

  • 18% (n=37) all-cause 6-month mortality observed.
  • Independent predictors of death included systemic embolization (HR 7.11), moderate/severe tricuspid regurgitation (HR 4.24), abnormal right ventricular function (HR 3.59), and abnormal renal function (HR 2.98).
  • Cardiac device vegetation size and mobility were not independently associated with mortality.

Conclusions:

  • Several clinical and echocardiographic variables identify high-risk patients.
  • These factors may guide more aggressive patient evaluation and management.
  • Systemic embolization and cardiac/renal dysfunction are critical prognostic indicators.
Abstract

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