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Published on: February 28, 2012
Association of the Timing and Extent of Cardiac Implantable Electronic Device Infections With Mortality
Hui-Chen Han1,2, Jia Wang3, David H Birnie4
1Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Cardiac implantable electronic device (CIED) infections occurring early and systemically, or delayed and localized, significantly increase mortality risk. Delayed systemic CIED infections pose the highest mortality risk, underscoring the need for prompt diagnosis and treatment.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Cardiac implantable electronic device (CIED) infections represent a serious complication with high mortality rates.
- The specific impact of infection timing and extent on mortality remains incompletely understood.
Purpose of the Study:
- To investigate the association between the timing (early vs. delayed) and extent (localized vs. systemic) of CIED infections and all-cause mortality.
Main Methods:
- A prospective observational cohort study involving 19,559 patients across 28 centers in Canada and the Netherlands.
- Time-dependent analysis was used to assess mortality risk based on prospectively identified CIED infections.
Main Results:
- Infections were most common within the first 3 months post-procedure.
- Early systemic and delayed localized infections were associated with a 3-fold increase in mortality.
- Delayed systemic CIED infections presented the highest mortality risk, with a 9.3-fold increased hazard ratio.
Conclusions:
- CIED infections occurring systemically early or localized late significantly elevate mortality risk.
- Delayed systemic infections carry the most substantial mortality risk.
- Prompt identification and management of CIED infections are crucial for mitigating patient mortality.
Importance:
Cardiac implantable electronic device (CIED) infection is a potentially devastating complication with an estimated 12-month mortality of 15% to 30%. The association of the extent (localized or systemic) and timing of infection with all-cause mortality has not been established.
Objective:
To evaluate the association of the extent and timing of CIED infection with all-cause mortality.
Design, Setting, And Participants:
This prospective observational cohort study was conducted between December 1, 2012, and September 30, 2016, in 28 centers across Canada and the Netherlands. The study included 19 559 patients undergoing CIED procedures, 177 of whom developed an infection. Data were analyzed from April 5, 2021, to January 14, 2023.
Exposures:
Prospectively identified CIED infections.
Main Outcomes And Measures:
Time-dependent analysis of the timing (early [≤3 months] or delayed [3-12 months]) and extent (localized or systemic) of infection was performed to determine the risk of all-cause mortality associated with CIED infections.
Results:
Of 19 559 patients undergoing CIED procedures, 177 developed a CIED infection. The mean (SD) age was 68.7 (12.7) years, and 132 patients were male (74.6%). The cumulative incidence of infection was 0.6%, 0.7%, and 0.9% within 3, 6, and 12 months, respectively. Infection rates were highest in the first 3 months (0.21% per month), reducing significantly thereafter. Compared with patients who did not develop CIED infection, those with early localized infections were not at higher risk for all-cause mortality (no deaths at 30 days [0 of 74 patients]: adjusted hazard ratio [aHR], 0.64 [95% CI, 0.20-1.98]; P = .43). However, patients with early systemic and delayed localized infections had an approximately 3-fold increase in mortality (8.9% 30-day mortality [4 of 45 patients]: aHR, 2.88 [95% CI, 1.48-5.61]; P = .002; 8.8% 30-day mortality [3 of 34 patients]: aHR, 3.57 [95% CI, 1.33-9.57]; P = .01), increasing to a 9.3-fold risk of death for those with delayed systemic infections (21.7% 30-day mortality [5 of 23 patients]: aHR, 9.30 [95% CI, 3.82-22.65]; P < .001).
Conclusions And Relevance:
Findings suggest that CIED infections are most common within 3 months after the procedure. Early systemic infections and delayed localized infections are associated with increased mortality, with the highest risk for patients with delayed systemic infections. Early detection and treatment of CIED infections may be important in reducing mortality associated with this complication.
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