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

Autor:	Han HC; Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.; Victorian Heart Institute, Monash University, Clayton, Victoria, Australia., Wang J; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada., Birnie DH; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada., Alings M; Division of Cardiology, Amphia Ziekenhuis & Working Group on Cardiovascular Research the Netherlands (WCN), Breda, the Netherlands., Philippon F; Division of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, Quebec, Canada., Parkash R; Division of Cardiology, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada., Manlucu J; Division of Cardiology, Lawson Health Research Institute, London Health Sciences, Western University, London, Ontario, Canada., Angaran P; Division of Cardiology, Department of Medicine, University of Toronto, St Michael Hospital, Toronto, Ontario, Canada., Rinne C; Division of Cardiology, St Mary's General Hospital, Kitchener, Ontario, Canada., Coutu B; Division of Cardiology, Centre hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada., Low RA; Division of Cardiology, Chinook Regional Hospital, Lethbridge, Alberta, Canada., Essebag V; Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada.; Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada., Morillo C; Division of Cardiology, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada., Healey JS; Division of Cardiology, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada., Redfearn D; Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada., Toal S; Division of Cardiology, Horizon Health Network, Saint John, New Brunswick, Canada., Becker G; Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada., DeGrâce M; Division of Cardiology, Hôtel-Dieu de Lévis, Levis, Montreal, Quebec, Canada., Thibault B; Division of Cardiology, Montreal Heart Institute, Montreal, Quebec, Canada., Crystal E; Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada., Tung S; Division of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada., LeMaitre J; Division of Cardiology, Royal Columbian Hospital, New Westminster, British Columbia, Canada., Sultan O; Division of Cardiology, Regina General Hospital, Saskatchewan Health Authority, Regina, Saskatchewan, Canada., Bennett M; Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada., Bashir J; Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada., Ayala-Paredes F; Division of Cardiology, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Montreal, Quebec, Canada., Gervais P; Division of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, Quebec, Canada., Rioux L; Division of Cardiology, Centre Intégré de Sante et Service Sociaux du Bas-Laurent (CISSSBSL), Rimouski, Montreal, Quebec, Canada., Hemels MEW; Division of Cardiology, Rijnstate Hospital, Arnhem, the Netherlands.; Division of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands., Bouwels LHR; Division of Cardiology, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands., Exner DV; Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada., Dorian P; Division of Cardiology, Department of Medicine, University of Toronto, St Michael Hospital, Toronto, Ontario, Canada., Connolly SJ; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada., Longtin Y; Jewish General Hospital Sir Mortimer B. Davis, McGill University, Montreal, Quebec, Canada., Krahn AD; Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
Jazyk:	angličtina
Zdroj:	JAMA cardiology [JAMA Cardiol] 2023 May 01; Vol. 8 (5), pp. 484-491.
DOI:	10.1001/jamacardio.2023.0467
Abstrakt:	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.
Databáze:	MEDLINE
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