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Differences of Mortality Rates between Pocket and Nonpocket Cardiovascular Implantable Electronic Device Infections
Journal article   Peer reviewed

Differences of Mortality Rates between Pocket and Nonpocket Cardiovascular Implantable Electronic Device Infections

Dong Heun Lee, Edward J Gracely, Sarah Y Aleem, Steven P Kutalek and Ole Vielemeyer
Pacing and clinical electrophysiology, v 38(12), pp 1456-1463
Dec 2015
DOI: https://doi.org/10.1111/pace.12748
PMID: 26351247
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

Age Distribution Bacteremia - mortality Defibrillators, Implantable - statistics & numerical data Equipment Design Equipment Failure - statistics & numerical data Equipment Failure Analysis Female Hospital Mortality Humans Incidence Male Pacemaker, Artificial - statistics & numerical data Philadelphia - epidemiology Prosthesis-Related Infections - mortality Risk Assessment - methods Sex Distribution Survival Rate
A steady rise in the use of cardiovascular implantable electronic devices (CIEDs), particularly in the elderly, has led to an increase in device-related infections. Although often studied and reported as a single entity, these complications in fact comprise a heterogeneous group. Specific subgroups may be associated with distinct mortality risks. Medical records of all patients who underwent device extraction for CIED-related infection at a single tertiary referral center between 1991 and 2007 were reviewed. Infections were divided into four subgroups: primary pocket site infection (PPSI), pocket site infection with bacteremia, primary/isolated bacteremia (PIB), and device-related infective endocarditis (DRIE). Clinical presentation, laboratory data, and mortality rates were obtained by chart review and by querying the Social Security Death Index. A total of 387 cases were analyzed. The overall in-hospital and 1-year all-cause mortality rates were 7.2% and 25.3%, respectively. Patients with PIB or DRIE had significantly higher mortality rates (hazard ratio [HR] 2.3; 95% confidence interval [CI] 1.2-4.6 and HR 2.5; 95% CI 1.6-4.1, respectively) when compared with patients in the PPSI group. Patients who did not receive a new device during the initial admission also had a higher 1-year mortality rate compared to those who did (HR 2.7; 95% CI 1.8-4.1). Our patients with CIED-related infections requiring extraction/hospitalization had a significant mortality risk. Presence of pocket site infection carried a more favorable prognosis, regardless of the presence of bacteremia. Early detection and prevention of CIED-related infections with PIB (i.e., no pocket site involvement), especially for high-risk populations, is needed.

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21 citations in Web of Science
24 citations in Scopus

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Collaboration types
Domestic collaboration
Web of Science research areas
Cardiac & Cardiovascular Systems
Engineering, Biomedical
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