TY - JOUR
AU - Nielsen, J C
AB - Introduction: Cardiac implantable electronic devices (CIED), including pacemakers (PM), implantable cardioverter defibrillators (ICD) and cardiac resynchronisation therapy devices (CRT), are implanted worldwide in increasing numbers. CIED infection is a complication associated with increased morbidity and health care costs, and according to some studies increased mortality. Purpose: We aimed to provide data on incidence of CIED infection leading to CIED extraction, and to identify predictors of CIED infection during long-term follow up in a complete, contemporary and nationwide cohort of consecutive CIED patients. Methods: A nationwide, cohort study was performed including all patients who underwent a CIED procedure in Denmark from May 2010 to April 2011. Data came from the Danish Pacemaker and ICD Registry. Cumulative incidence proportions for CIED infection adjusted for competing risk (death) were generated according to CIED and procedure type. Cox proportional hazard regression analysis was used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for the association between selected predictors and CIED infection. Results: The study population consisted of 5,918 consecutive patients; women: n=2,211, median age: 74 (interquartile range 65–83) years, PM: n=4,189, CRT-P or CRT-D: n=654, ICD: n=1,075, first implant as index procedure: n=4,355, reintervention as index procedure: n=1,563. During median follow up time of 6.1 (2.8–6.9) years, a total of 100 patients (1.7%) had CIED infection leading to extraction. CIED type extracted was PM (n=56), ICD (n=24) or CRT (n=20). All leads were extracted in total, except in two patients with single-lead ventricular PMs in whom leads were abandoned. Risk of infection was low for primary implants as index procedure, especially PM implantations, Figure A. Risk of infection was high with reintervention as index procedure, especially CRT, Figure B. In multivariate analyses, increased risk of CIED infection was observed in patients who underwent reintervention as index procedure (aHR 2.2; 95% CI 1.5–3.3, p value <0.001), had CRT (aHR 1.8; 95% CI 1.0–3.0, p value 0.04), C-reactive protein≥20.0 mg/L within 1 day of index procedure (aHR 1.9; 95% CI 1.1–3.4, p value 0.03) or had wound infection treated with antibiotics (aHR 3.0; 95% CI 1.1–8.1, p value 0.03). Patients older than 80 years had decreased risk of CIED infection (aHR 0.4; 95% CI 0.2–0.8, p value 0.01). After CIED infection, 81/100 patients (81%) underwent CIED reimplantation. Open in new tabDownload slide Cumulative incidence of CIED infection Conclusions: In a nationwide cohort of consecutive CIED patients, risk of CIED infection was low (1.7%) during long-term follow up. These results may be used as benchmark for future CIED treatment. Reinterventions carried a higher risk of CIED infection and thus reducing risk of reintervention by meticulous surgical technique and proper CIED selection at primary implant is essential. Acknowledgement/Funding: The study was supported by unrestricted research grants from The Danish Pacemaker and ICD Register and the Central Denmark Region Research Foundation. © The European Society of Cardiology 2018. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) © The European Society of Cardiology 2018. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
TI - 5308Incidence and predictors of cardiac implantable electronic device infection: long-term follow up in a complete, nationwide Danish cohort
JF - European Heart Journal
DO - 10.1093/eurheartj/ehy566.5308
DA - 2018-08-01
UR - https://www.deepdyve.com/lp/oxford-university-press/5308incidence-and-predictors-of-cardiac-implantable-electronic-device-0rgS8jnAkK
VL - 39
IS - suppl_1
DP - DeepDyve
ER -