Impact of timing of device removal on mortality in patients with cardiovascular implantable electronic device infections

Katherine Y. Le, Muhammad R. Sohail, Paul Andrew Friedman, Daniel Z. Uslan, Stephen S. Cha, David L. Hayes, Walter R. Wilson, James M. Steckelberg, Larry M. Baddour

Research output: Contribution to journalArticle

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Abstract

Background: Cardiovascular implantable electronic device (CIED) infections are associated with increased mortality. However, detailed analyses of the impact of device removal on mortality have been limited. Objective: This study sought to evaluate the impact of timing device removal on mortality in patients with CIED infections. Methods: We retrospectively reviewed all cases of CIED infections seen at Mayo Clinic Rochester between 1991 and 2008. The impact of device removal on 30-day and 1-year mortality was evaluated using Cox proportional hazards models. Results: Of 416 patients with CIED infection, 23 (5.5%) died by 30 days and 61 (14.6%) died by 1 year. Forty-four (12.0%) developed complications related to device removal, and 3 (0.8%) died. Complete procedural success was achieved in 341 (81.9%) and clinical success in 391 (93.9%) cases. In multivariate analysis, antimicrobial therapy without device removal was associated with a 7-fold increase in 30-day mortality (hazard ratio [HR] 6.97, 95% confidence interval [CI] 1.36 to 35.60). Although device removal complications were associated with increased mortality at 30 days (HR 4.33, 95% CI 1.47 to 12.70) and at 1 year (HR 3.77, 95% CI 1.88 to 7.55), immediate device removal, when compared to delay in device removal in favor of initial conservative therapy with antimicrobials alone, and no device removal, was associated with a 3-fold decrease in 1-year mortality (HR 0.35, 95% CI 0.16 to 0.75). Conclusion: Although device removal resulted in fatal complications in a few patients, the mortality associated with a delay in device removal was significantly higher. Therefore, early and complete device removal was associated with improved outcomes.

Original languageEnglish (US)
Pages (from-to)1678-1685
Number of pages8
JournalHeart Rhythm
Volume8
Issue number11
DOIs
StatePublished - Nov 2011

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Device Removal
Equipment and Supplies
Mortality
Infection
Confidence Intervals
Proportional Hazards Models

Keywords

  • Complications
  • Implantable cardioverter-defibrillator
  • Infection
  • Mortality
  • Pacemakers

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Impact of timing of device removal on mortality in patients with cardiovascular implantable electronic device infections. / Le, Katherine Y.; Sohail, Muhammad R.; Friedman, Paul Andrew; Uslan, Daniel Z.; Cha, Stephen S.; Hayes, David L.; Wilson, Walter R.; Steckelberg, James M.; Baddour, Larry M.

In: Heart Rhythm, Vol. 8, No. 11, 11.2011, p. 1678-1685.

Research output: Contribution to journalArticle

Le, KY, Sohail, MR, Friedman, PA, Uslan, DZ, Cha, SS, Hayes, DL, Wilson, WR, Steckelberg, JM & Baddour, LM 2011, 'Impact of timing of device removal on mortality in patients with cardiovascular implantable electronic device infections', Heart Rhythm, vol. 8, no. 11, pp. 1678-1685. https://doi.org/10.1016/j.hrthm.2011.05.015
Le, Katherine Y. ; Sohail, Muhammad R. ; Friedman, Paul Andrew ; Uslan, Daniel Z. ; Cha, Stephen S. ; Hayes, David L. ; Wilson, Walter R. ; Steckelberg, James M. ; Baddour, Larry M. / Impact of timing of device removal on mortality in patients with cardiovascular implantable electronic device infections. In: Heart Rhythm. 2011 ; Vol. 8, No. 11. pp. 1678-1685.
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abstract = "Background: Cardiovascular implantable electronic device (CIED) infections are associated with increased mortality. However, detailed analyses of the impact of device removal on mortality have been limited. Objective: This study sought to evaluate the impact of timing device removal on mortality in patients with CIED infections. Methods: We retrospectively reviewed all cases of CIED infections seen at Mayo Clinic Rochester between 1991 and 2008. The impact of device removal on 30-day and 1-year mortality was evaluated using Cox proportional hazards models. Results: Of 416 patients with CIED infection, 23 (5.5{\%}) died by 30 days and 61 (14.6{\%}) died by 1 year. Forty-four (12.0{\%}) developed complications related to device removal, and 3 (0.8{\%}) died. Complete procedural success was achieved in 341 (81.9{\%}) and clinical success in 391 (93.9{\%}) cases. In multivariate analysis, antimicrobial therapy without device removal was associated with a 7-fold increase in 30-day mortality (hazard ratio [HR] 6.97, 95{\%} confidence interval [CI] 1.36 to 35.60). Although device removal complications were associated with increased mortality at 30 days (HR 4.33, 95{\%} CI 1.47 to 12.70) and at 1 year (HR 3.77, 95{\%} CI 1.88 to 7.55), immediate device removal, when compared to delay in device removal in favor of initial conservative therapy with antimicrobials alone, and no device removal, was associated with a 3-fold decrease in 1-year mortality (HR 0.35, 95{\%} CI 0.16 to 0.75). Conclusion: Although device removal resulted in fatal complications in a few patients, the mortality associated with a delay in device removal was significantly higher. Therefore, early and complete device removal was associated with improved outcomes.",
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AU - Le, Katherine Y.

AU - Sohail, Muhammad R.

AU - Friedman, Paul Andrew

AU - Uslan, Daniel Z.

AU - Cha, Stephen S.

AU - Hayes, David L.

AU - Wilson, Walter R.

AU - Steckelberg, James M.

AU - Baddour, Larry M.

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AB - Background: Cardiovascular implantable electronic device (CIED) infections are associated with increased mortality. However, detailed analyses of the impact of device removal on mortality have been limited. Objective: This study sought to evaluate the impact of timing device removal on mortality in patients with CIED infections. Methods: We retrospectively reviewed all cases of CIED infections seen at Mayo Clinic Rochester between 1991 and 2008. The impact of device removal on 30-day and 1-year mortality was evaluated using Cox proportional hazards models. Results: Of 416 patients with CIED infection, 23 (5.5%) died by 30 days and 61 (14.6%) died by 1 year. Forty-four (12.0%) developed complications related to device removal, and 3 (0.8%) died. Complete procedural success was achieved in 341 (81.9%) and clinical success in 391 (93.9%) cases. In multivariate analysis, antimicrobial therapy without device removal was associated with a 7-fold increase in 30-day mortality (hazard ratio [HR] 6.97, 95% confidence interval [CI] 1.36 to 35.60). Although device removal complications were associated with increased mortality at 30 days (HR 4.33, 95% CI 1.47 to 12.70) and at 1 year (HR 3.77, 95% CI 1.88 to 7.55), immediate device removal, when compared to delay in device removal in favor of initial conservative therapy with antimicrobials alone, and no device removal, was associated with a 3-fold decrease in 1-year mortality (HR 0.35, 95% CI 0.16 to 0.75). Conclusion: Although device removal resulted in fatal complications in a few patients, the mortality associated with a delay in device removal was significantly higher. Therefore, early and complete device removal was associated with improved outcomes.

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KW - Mortality

KW - Pacemakers

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