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Observational Study
. 2023 May 1;8(5):484-491.
doi: 10.1001/jamacardio.2023.0467.

Association of the Timing and Extent of Cardiac Implantable Electronic Device Infections With Mortality

Hui-Chen Han  1   2 , Jia Wang  3 , David H Birnie  4 , Marco Alings  5 , François Philippon  6 , Ratika Parkash  7 , Jaimie Manlucu  8 , Paul Angaran  9 , Claus Rinne  10 , Benoit Coutu  11 , R Aaron Low  12 , Vidal Essebag  13   14 , Carlos Morillo  15 , Jeffrey S Healey  16 , Damian Redfearn  17 , Satish Toal  18 , Giuliano Becker  14 , Michel DeGrâce  19 , Bernard Thibault  20 , Eugene Crystal  21 , Stanley Tung  22 , John LeMaitre  23 , Omar Sultan  24 , Matthew Bennett  25 , Jamil Bashir  1 , Felix Ayala-Paredes  26 , Philippe Gervais  6 , Leon Rioux  27 , Martin E W Hemels  28   29 , Leon H R Bouwels  30 , Derek V Exner  14 , Paul Dorian  9 , Stuart J Connolly  3 , Yves Longtin  31 , Andrew D Krahn  1
Affiliations
Observational Study

Association of the Timing and Extent of Cardiac Implantable Electronic Device Infections With Mortality

Hui-Chen Han et al. JAMA Cardiol. .

Abstract

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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Conflict of interest statement

Conflict of Interest Disclosures: Dr Philippon reported receiving grants from Medtronic and Boston Scientific outside the submitted work. Dr Parkash reported receiving grants from Medtronic and Abbott outside the submitted work. Dr Morillo reported receiving advisory board fees from Medtronic, Abbott, and BSCI; speaker fees from Medtronic and BSCI; and grants from Servier and Novartis outside the submitted work. Dr Healey reported receiving grants from Boston Scientific and Medtronic outside the submitted work. Dr Crystal reported receiving grants for continuing medical education from Boston Scientific, Biotronik, Medtronic, Biosense Webster, and Abbott outside the submitted work. Dr Longtin reported receiving grants from Summit (Oxford) Limited outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Infection Rate Over Time Estimated by the Cumulative Incidence Function Method
Figure 2.
Figure 2.. Monthly Infection Rate According to Extent of Infection
See this image and copyright information in PMC

References

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