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Infective Endocarditis After Arrythmia Device Implantation in Cardiac Surgery Patients
Andreas Martinsson1,2, Sigurdur Thorleifsson1,2, Alice David1,2
1Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden.
Insights
Implanting cardiac devices after heart surgery increases infective endocarditis (IE) risk and mortality. Risk factors include surgery type and patient health.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Devices
Background:
- Cardiac surgery patients have elevated infective endocarditis (IE) risk.
- Cardiac implantable electronic devices (CIEDs) may further increase IE risk in these patients.
Purpose of the Study:
- To evaluate the risk of IE following CIED implantation within 30 days of cardiac surgery.
- To identify risk factors associated with IE in this patient population.
Main Methods:
- Nationwide registry study in Sweden (2006-2020) including first-time cardiac surgery patients without prior CIEDs.
- Cox proportional hazards models were used to analyze the association between CIED implantation and IE risk, adjusting for covariates.
Main Results:
- 3.1% of 73,367 patients received a CIED within 30 days post-surgery.
- CIED implantation was linked to a 46% increased IE risk (aHR, 1.46).
- IE significantly increased mortality risk (aHR, 1.80); valvular surgery and comorbidities like diabetes were associated with higher IE incidence.
Conclusions:
- CIED implantation shortly after cardiac surgery elevates long-term IE and mortality risks.
- The type of cardiac surgery and patient comorbidities are significant factors influencing IE risk.
Background:
Patients undergoing cardiac surgery face an increased risk of infective endocarditis (IE), a risk that may be further exacerbated by implantation of cardiac implantable electronic devices (CIED). This study aimed to assess the risk of IE after CIED implantation within 30 days of cardiac surgery and identify associated risk factors.
Methods:
All patients in Sweden, with no previous CIED, who underwent first-time cardiac surgery between 2006 and 2020 were included in this nationwide registry-based study. Cox proportional hazards models adjusted for demographic and clinical covariates were used to estimate the association between CIED implantation and the risk of IE.
Results:
Out of 73 367 patients, 2302 (3.1%) received a CIED within 30 days. Over a median follow-up of 6.5 years (interquartile range, 3.2-10.1 years), 1556 patients (2.1%) developed IE. CIED implantation was associated with an increased IE risk (adjusted hazard ratio [aHR], 1.46 [95% CI, 1.20-1.77]). Patients with IE had a significantly higher risk of mortality compared with those without IE (aHR, 1.80 [95% CI, 1.67-1.94]; P<0.001). The type of cardiac surgery influenced IE risk, with valvular surgeries showing a higher incidence than coronary artery bypass grafting. Risk factors independently associated with IE included male sex, age at surgery, diabetes, and peripheral vascular disease.
Conclusions:
CIED implantation within 30 days after cardiac surgery is associated with an increased long-term risk of IE and subsequent mortality. The type of surgery and patient comorbidities influence the risk.
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