Comparison of outcomes in infected cardiovascular implantable electronic devices between complete, partial, and failed lead removal: an ESC-EHRA-EORP ELECTRa (European Lead Extraction ConTrolled) registry.

Autor:	Nof, Eyal, Bongiorni, Maria Grazia, Auricchio, Angelo, Butter, Christian, Dagres, Nikolaos, Deharo, Jean-Claude, Rinaldi, Christopher A, Maggioni, Aldo P, Kutarski, Andrzej, Kennergren, Charles, Laroche, Cécile, Milman, Anat, Beinart, Roy, Bogdan, Stefan, Mortsell, David, Calvi, Valeria, Desiron, Quentin, Mansourati, Jacques, Lundqvist, Carina Blomstrom, Glikson, Michael
Předmět:	ANTIBIOTICS ELECTRODES RESEARCH MEDICAL device removal TIME AGE distribution RESEARCH methodology IMPLANTABLE cardioverter-defibrillators ARTIFICIAL implants ACQUISITION of data EVALUATION research MEDICAL cooperation INFECTION TREATMENT failure TREATMENT effectiveness COMPARATIVE studies CARDIAC pacemakers COMPLICATIONS of prosthesis
Zdroj:	EP: Europace; Dec2019, Vol. 21 Issue 12, p1876-1889, 14p
Abstrakt:	Aims: The present study sought to determine predictors for success and outcomes of patients who underwent cardiac implantable electronic devices (CIED) extraction indicated for systemic or local CIED related infection in particular where complete lead removal could not be achieved.Methods and Results: ESC-EORP ELECTRa (European Lead Extraction ConTRolled Registry) is a European prospective lead extraction registry. Out of the total cohort, 1865/3510 (52.5%) patients underwent removal due to CIED related infection. Predictors and outcomes of failure were analysed. Complete removal was achieved in 1743 (93.5%) patients, partial (<4 cm of lead left) in 88 (4.7%), and failed (>4 cm of lead left) in 32 (1.8%) patients. Removal success was unrelated to type of CIED infection (pocket or systemic). Predictors for failure were older leads and older patients [odds ratio (OR) 1.14 (1.08-1.19), P < 0.0001 and OR 2.68 (1.22-5.91), P = 0.0146, respectively]. In analysis by lead, predictors for failure were: pacemaker vs. defibrillator removal and failure to engage the locking stylet all the way to the tip [OR 0.20 (0.04-0.95), P = 0.03 and OR 0.32 (0.13-0.74), P = 0.008, respectively]. Significantly higher complication rates were noted in the failure group (40.6% vs. 15.9 for partial and 8.7% for success groups, P < 0.0001). Failure to remove a lead was a strong predictor for in hospital mortality [hazard ratio of 2.05 (1.01-4.16), P = 0.046].Conclusion: A total of 6.5% of infected CIED patients failed attempted extraction. Only were >4 cm of lead remained resulted in higher procedural complications and mortality rates. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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