Impact of Abandoned Leads on Cardiovascular Implantable Electronic Device Infections
Autor: | Arnold J. Greenspon, José M. Miró, Thomas A. Boyle, Larry M. Baddour, Katherine Y. Le, Medic Investigators, Holenarasipur R. Vikram, Stephan B. Danik, Daniel Z. Uslan, José María Tolosana, Jordan M. Prutkin, Roger G. Carrillo, James E. Peacock, Muhammad R. Sohail |
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Rok vydání: | 2018 |
Předmět: |
medicine.medical_specialty
business.industry 030204 cardiovascular system & hematology Device type medicine.disease 03 medical and health sciences 0302 clinical medicine Charlson comorbidity index Internal medicine Clinical information Cohort Propensity score matching medicine Endocarditis 030212 general & internal medicine Intensive care medicine business Lead extraction |
Zdroj: | JACC: Clinical Electrophysiology. 4:201-208 |
ISSN: | 2405-500X |
Popis: | Objectives This study sought to evaluate the impact of abandoned cardiovascular implantable electronic device (CIED) leads on the presentation and management of device-related infections. Background Device infection is a serious consequence of CIEDs and necessitates removal of all hardware for attempted cure. The merits of extracting or retaining presumed sterile but nonfunctioning leads is a subject of ongoing debate. Methods The MEDIC (Multicenter Electrophysiologic Device Infection Cohort) prospectively enrolled patients with CIED infections at 10 institutions in the United States and abroad between January 1, 2009, and December 31, 2012. Within a propensity-matched cohort, relevant clinical information was compared between patients who had 1 or more abandoned leads at the time of infection and those who had none. Results Matching produced a cohort of 264 patients, including 176 with no abandoned leads and 88 with abandoned leads. The groups were balanced with respect to Charlson comorbidity index, oldest lead age, device type, sex, and race. At the time of admission, those with abandoned leads were less likely to demonstrate systemic signs of infection, including leukocytosis (p = 0.023) and positive blood cultures (p = 0.005). Conversely, patients with abandoned leads were more likely to demonstrate local signs of infections, including skin erosion (p = 0.031) and positive pocket cultures (p = 0.015). In addition, patients with abandoned leads were more likely to require laser extraction (p = 0.010). Conclusions The results of a large prospective registry of CIED infections demonstrated that patients with abandoned leads may present with different signs, symptoms, and microbiological findings and require laser extraction more than those without abandoned leads. |
Databáze: | OpenAIRE |
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