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Outcomes in patients undergoing cardiac resynchronization therapy complicated by device-related infective endocarditis.
Kardiologia Polska 2018 August 10
BACKGROUND: Cardiac device-related infective endocarditis (CDRIE) is one of the most serious complications of cardiac resynchronization therapy (CRT).
AIM: The aim of the study was to assess clinical outcomes and their determinants in CRT patients with CDRIE.
METHODS: Tertiary cardiology centre database was screened to identify all CDRIE cases, based on modified Duke criteria, amongst 765 consecutive CRT implantations between 2002 and 2015 (70.8% de novo implantations, 29.2% up-grades).
RESULTS: During the median follow-up (FU) of 1692 days (range: 457-3067), CDRIE has been diagnosed in 41 patients (5.4%). Overall, in-hospital and remote mortality rates of CDRIE patients were 51.2% and 75.6%, respectively. Of patients with CDRIE, in whom device was versus was not explanted in-hospital death rates were 39.3% (11/28 patients) versus 76.9% (10/13 patients; P = 0.025). On multivariable regression analysis, the device removal was independently associated with significantly lower in-hospital mortality (HR 0.09, 95% CI 0.03-0.35, P = 0.0004). The need for temporary pacing after device removal (HR 5.92, 95% CI 1.13-30.96, P = 0.035), a time period of < 7 days between CDRIE diagnosis and CRT removal (HR 6.69, 95% CI 1.48-30.27, P = 0.01) and the highest serum creatinine level during infection (HR 1.02, 95% CI 1.004-1.03, P = 0.01) were identified as independent predictors of higher in-hospital mortality.
CONCLUSIONS: Device removal is independently associated with lower mortality in patients with CRT and CDRIE. Early device removal (< 7 days), the need for temporary pacing after removal and acute renal failure are independent mortality predictors in patients with CRT who developed CDRIE.
AIM: The aim of the study was to assess clinical outcomes and their determinants in CRT patients with CDRIE.
METHODS: Tertiary cardiology centre database was screened to identify all CDRIE cases, based on modified Duke criteria, amongst 765 consecutive CRT implantations between 2002 and 2015 (70.8% de novo implantations, 29.2% up-grades).
RESULTS: During the median follow-up (FU) of 1692 days (range: 457-3067), CDRIE has been diagnosed in 41 patients (5.4%). Overall, in-hospital and remote mortality rates of CDRIE patients were 51.2% and 75.6%, respectively. Of patients with CDRIE, in whom device was versus was not explanted in-hospital death rates were 39.3% (11/28 patients) versus 76.9% (10/13 patients; P = 0.025). On multivariable regression analysis, the device removal was independently associated with significantly lower in-hospital mortality (HR 0.09, 95% CI 0.03-0.35, P = 0.0004). The need for temporary pacing after device removal (HR 5.92, 95% CI 1.13-30.96, P = 0.035), a time period of < 7 days between CDRIE diagnosis and CRT removal (HR 6.69, 95% CI 1.48-30.27, P = 0.01) and the highest serum creatinine level during infection (HR 1.02, 95% CI 1.004-1.03, P = 0.01) were identified as independent predictors of higher in-hospital mortality.
CONCLUSIONS: Device removal is independently associated with lower mortality in patients with CRT and CDRIE. Early device removal (< 7 days), the need for temporary pacing after removal and acute renal failure are independent mortality predictors in patients with CRT who developed CDRIE.
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