Lead-related infective endocarditis: Factors influencing early and long-term survival in patients undergoing transvenous lead extraction

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• 作者：Anna Polewczyk ; MD ; PhD^⁎ ; ^&dagger ; ; ^{annapolewczyk@wp.pl} ; Wojciech Jacheć ; MD ; PhD^&Dagger ; ; Andrzej Tomaszewski ; MD ; PhD^§ ; ; Wojciech Brzozowski ; MD ; PhD^§ ; ; Marek Czajkowski ; MD ; PhD^¶ ; ; Grzegorz Opolski ; MD ; PhD^# ; Marcin Grabowski ; MD ; PhD^# ; Marianna Janion ; MD ; PhD^⁎ ; ^&dagger ; ; Andrzej Kutarski ; MD ; PhD^§ ;
• 关键词：Lead-related infective endocarditis ; Generator pocket infection ; Transvenous lead extraction ; Prognosis ; Vegetation remnants
• 刊名：Heart Rhythm
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：14
• 期：1
• 页码：43-49
• 全文大小：607 K
• 卷排序：14

文摘

Lead-related infective endocarditis (LRIE) is a serious infectious disease with uncertain prognosis.ObjectiveThe purpose of this study was to evaluate the factors that influence survival in patients with LRIE undergoing transvenous lead extraction (TLE).MethodsClinical data obtained from 500 consecutive patients with LRIE undergoing TLE in the reference center in the years 2006 to 2015 were retrospectively analyzed. We evaluated the effect of demographic, clinical, and procedure-related factors on 30-day and long-term survival (mean 3-year follow-up).ResultsAnalysis of 30-day survival after TLE revealed 19 deaths (3.8%), with long-term mortality (mean 3-year follow-up) of 29.3% (146 deaths). Multivariate analysis showed unfavorable effects of age (hazard ratio [HR] 1.056, 95% confidence interval [CI] 1.030–1.082); decreased left ventricular ejection fraction (HR 0.687, 95% CI 0.545–0.866); renal failure (HR 3.099, 95% CI 1.865–5.150); and presence of vegetation fragments remaining after TLE (HR 1.384, 95% CI 1.089–1.760). Log-rank test and Kaplan–Meier survival curves demonstrated statistically worse prognosis in patients with large vegetations (>2 cm) and with vegetation remnants. Better prognosis was associated with LRIE coexisting with generator pocket infection.ConclusionLong-term mortality in LRIE patients is still high. Factors that influence negatively on prognosis include large cardiac vegetations and their remnants after TLE. Such vegetations develop most frequently in patients with decreased left ventricular ejection fraction and renal failure. Probably, early detection of LRIE would tend to limit the formation of large vegetations that invade the adjacent cardiac structures.