Clinical Outcomes of Cardiac Implantable Electronic Device-Related Endocarditis: An International ID-IRI Study

Abstract

Background/Objectives: Cardiac implantable electronic device-related infective endocarditis (CIED-RIE) is a serious condition with significant morbidity and mortality. Although recent advances in imaging and therapeutic approaches have improved management, diagnosing and treating CIED-RIE continues to be challenging. This study aimed to identify factors associated with mortality in CIED-RIE patients. Methods: We conducted a retrospective, multicenter international study of adult patients diagnosed with CIED-RIE between January 2014 and June 2024. Data on demographics, clinical presentation, microbiological findings, imaging results, treatment modalities, and outcomes were collected and analyzed to determine predictors of short-term mortality. Results: A total of 197 patients (mean age: 65.3 ± 14.4 years; 75.1% male) were included. The most common device type was permanent pacemaker (48.2%). Staphylococcus species were the predominant pathogens (62.4%). Surgical intervention was performed in 67.5% of patients, and 90-day mortality occurred in 19.3%. Multivariable analysis identified higher Charlson comorbidity index (HR: 1.31), tricuspid valve involvement (HR: 2.35), vegetation size ≥ 10 mm (HR: 2.53), pulmonary embolism (HR: 3.92), and absence of surgical intervention (HR: 2.90) as independent predictors of increased 90-day mortality. Conclusions: Early identification of high-risk patients and prompt multidisciplinary management, including surgical intervention when indicated, are critical to improving outcomes in patients with CIED-RIE.

Keywords: cardiac implantable electronic device; clinical outcome; endocarditis; mortality; transvenous lead extraction.

Figure 1

Kaplan–Meier Curves Showing the 90-Day Survival Probabilities in Patients With CIED-Related Infective Endocarditis. (A) Overall 90-day survival probability with confidence intervals. (B–I) Survival curves stratified by variables significantly associated with 90-day mortality.

Figure 2

Multivariable Cox Regression Analysis of Factors Associated With 90-Day Mortality in Patients With CIED-Related Infective Endocarditis. Hazard ratios (HR) with 95% confidence intervals are shown on a logarithmic scale for variables included in the multivariable model. Persistent bacteremia was not included in the model due to >10% missing data.