Device extraction improves survival in patients with CIED infection

Among patients with cardiovascular implantable electronic device (CIED) infection, only a few undergo device extraction, which lowers the risk of death, as shown in a study.

The study included 1,065,549 patients (median age 78.0 years, 50.9 percent men, 87.2 percent White, 68.3 percent had diabetes) who had a de novo CIED implantation. Device infection, device extraction, and all-cause mortality were the primary endpoints. Researchers used time-varying multivariable Cox proportional hazards regression models to evaluate the association between extraction and survival.

Over a mean follow-up of 4.6 years after implantation, 11,304 patients (1.1 percent, median age 75.0 years, 60.1 percent men, 77.2 percent White) had a CIED infection. CIED infection was characterized as endocarditis or infection of a device implant, as well as documented antibiotic therapy. Infection occurred a mean of 3.7 years after implantation, and the 1-year survival rate was 68.3 percent.

Patients with vs without CIED infection had higher rates of comorbidities such as diabetes, ischaemic heart disease, peripheral vascular disease, heart failure, chronic obstructive pulmonary disease, and kidney disease. CIED infections were more common among patients with a cardiac resynchronization therapy defibrillator (CRTD; 13.2 percent vs 8.2 percent) or ICD (29.5 percent vs 17.4 percent).

Of the patients with CIED infection, 2,102 (18.6 percent) underwent device extraction within 30 days of diagnosis. Extraction was performed within 6 days of diagnosis in 1,511 patients (13.4 percent) and between days 7 and 30 in 591 patients (5.2 percent).

Multivariable analysis showed that any extraction was associated with reduced mortality compared with no extraction (adjusted hazard ratio [aHR], 0.82, 95 percent confidence interval [CI], 0.74–0.90; p<0.001), with an earlier extraction (within 6 days) conferring greater survival benefit (aHR, 0.69, 95 percent CI, 0.61–0.78; p<0.001).

The findings underscore the importance of improving adherence to guideline-recommended device extraction among patients with CIED infection.