Low Utilization of Lead Extraction Among Patients With Infective Endocarditis and Implanted Cardiac Electronic Devices.

Autor:	Sciria CT; Department of Medicine, Division of Cardiology, Weill Cornell Medicine-New York Presbyterian Hospital and Weill Cornell Cardiovascular Outcomes Research Group (CORG), New York, New York, USA; Department of Medicine, Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA., Kogan EV; Department of Medicine, Division of Cardiology, Weill Cornell Medicine-New York Presbyterian Hospital and Weill Cornell Cardiovascular Outcomes Research Group (CORG), New York, New York, USA., Mandler AG; Department of Medicine, Division of Cardiology, Weill Cornell Medicine-New York Presbyterian Hospital and Weill Cornell Cardiovascular Outcomes Research Group (CORG), New York, New York, USA., Yeo I; Department of Medicine, Division of Cardiology, Weill Cornell Medicine-New York Presbyterian Hospital and Weill Cornell Cardiovascular Outcomes Research Group (CORG), New York, New York, USA., Simon MS; Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York, USA., Kim LK; Department of Medicine, Division of Cardiology, Weill Cornell Medicine-New York Presbyterian Hospital and Weill Cornell Cardiovascular Outcomes Research Group (CORG), New York, New York, USA., Ip JE; Department of Medicine, Division of Cardiology, Weill Cornell Medicine-New York Presbyterian Hospital and Weill Cornell Cardiovascular Outcomes Research Group (CORG), New York, New York, USA., Liu CF; Department of Medicine, Division of Cardiology, Weill Cornell Medicine-New York Presbyterian Hospital and Weill Cornell Cardiovascular Outcomes Research Group (CORG), New York, New York, USA., Markowitz SM; Department of Medicine, Division of Cardiology, Weill Cornell Medicine-New York Presbyterian Hospital and Weill Cornell Cardiovascular Outcomes Research Group (CORG), New York, New York, USA., Lerman BB; Department of Medicine, Division of Cardiology, Weill Cornell Medicine-New York Presbyterian Hospital and Weill Cornell Cardiovascular Outcomes Research Group (CORG), New York, New York, USA., Thomas G; Department of Medicine, Division of Cardiology, Weill Cornell Medicine-New York Presbyterian Hospital and Weill Cornell Cardiovascular Outcomes Research Group (CORG), New York, New York, USA., Cheung JW; Department of Medicine, Division of Cardiology, Weill Cornell Medicine-New York Presbyterian Hospital and Weill Cornell Cardiovascular Outcomes Research Group (CORG), New York, New York, USA. Electronic address: jac9029@med.cornell.edu.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Cardiology [J Am Coll Cardiol] 2023 May 02; Vol. 81 (17), pp. 1714-1725.
DOI:	10.1016/j.jacc.2023.02.042
Abstrakt:	Background: Cardiac implantable electronic device (CIED)-associated infections are associated with substantial morbidity, mortality, and costs. Guidelines have cited endocarditis as a Class I indication for transvenous lead removal/extraction (TLE) among patients with CIEDs. Objectives: The authors sought to study utilization of TLE among hospital admissions with infective endocarditis using a nationally representative database. Methods: Using the Nationwide Readmissions Database (NRD), 25,303 admissions for patients with CIEDs and endocarditis between 2016 and 2019 were evaluated on the basis of International Classification of Diseases-10th Revision, Clinical-Modification (ICD-10-CM) codes. Results: Among admissions for patients with CIEDs and endocarditis, 11.5% were managed with TLE. The proportion undergoing TLE increased significantly from 2016 to 2019 (7.6% vs 14.9%; P trend < 0.001). Procedural complications were identified in 2.7%. Index mortality was significantly lower among patients managed with TLE (6.0% vs 9.5%; P < 0.001). Presence of Staphylococcus aureus infection, implantable cardioverter-defibrillator, and large hospital size were independently associated with TLE management. TLE management was less likely with older age, female sex, dementia, and kidney disease. After adjustment for comorbidities, TLE was independently associated with significantly lower odds of mortality (adjusted OR: 0.47; 95% CI: 0.37-0.60 by multivariable logistic regression, and adjusted OR: 0.51; 95% CI: 0.40-0.66 by propensity score matching). Conclusions: Utilization of lead extraction among patients with CIEDs and endocarditis is low, even in the presence of low rates of procedural complications. Lead extraction management is associated with significantly lower mortality, and its use has trended upward between 2016 and 2019. Barriers to TLE for patients with CIEDs and endocarditis require investigation. Competing Interests: Funding Support and Author Disclosures This work was supported by grants from the Michael Wolk Heart Foundation, the New York Cardiac Center, Inc, and the New York Weill Cornell Medical Center Alumni Council. Dr Cheung has received consulting fees from Abbott, Biotronik, and Boston Scientific; has received research grant support from Boston Scientific; and has received fellowship grant support from Abbott, Biosense Webster, Biotronik, Boston Scientific, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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