Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American College of Cardiology, 81(17), 1714–1725. https://doi.org/10.1016/j.jacc.2023.02.042 Dr. Christopher Sciria et al.
Points
- Cardiac implantable electronic device (CIED)-associated infections have significant implications, but the utilization of transvenous lead removal/extraction (TLE) for endocarditis in CIED patients remains low.
- Only 11.5% of hospital admissions for CIED patients with endocarditis underwent TLE, despite a notable increase in TLE utilization from 2016 to 2019.
- Patients with TLE had a significantly lower mortality rate than those without TLE.
- Factors such as Staphylococcus aureus infection, implantable cardioverter-defibrillator, and large hospital size were associated with a higher likelihood of TLE management.
- Older age, female sex, dementia, and kidney disease were associated with a lower likelihood of TLE, and TLE was independently linked to reduced odds of mortality even after considering comorbidities.
Summary
Cardiac implantable electronic device (CIED)-associated infections pose significant risks and costs. Current guidelines recommend transvenous lead removal/extraction (TLE) as a primary treatment for endocarditis in CIED patients. This study aimed to examine the utilization of TLE in hospital admissions for infective endocarditis using a nationally representative database.
The researchers analyzed data from the Nationwide Readmissions Database (NRD) between 2016 and 2019, encompassing 25,303 admissions of CIED patients with endocarditis, based on International Classification of Diseases-10th Revision, Clinical-Modification (ICD-10-CM) codes.
The findings revealed that only 11.5% of admissions for CIED patients with endocarditis underwent TLE. However, there was a significant increase in the proportion of patients undergoing TLE from 2016 to 2019 (7.6% to 14.9%). Procedural complications were observed in 2.7% of cases. Notably, patients managed with TLE had a significantly lower mortality rate (6.0% vs 9.5%). Factors associated with TLE management included Staphylococcus aureus infection, implantable cardioverter-defibrillator, and large hospital size. Conversely, older age, female sex, dementia, and kidney disease were associated with a lower likelihood of TLE. After accounting for comorbidities, TLE was independently linked to significantly reduced odds of mortality.
In conclusion, the utilization of lead extraction in CIED patients with endocarditis remains low, despite the low incidence of procedural complications. However, the study observed an upward trend in TLE utilization from 2016 to 2019. Further investigation is needed to identify and address the barriers hindering TLE implementation in this patient population.
Link to the article: https://www.jacc.org/doi/full/10.1016/j.jacc.2023.02.042
References Sciria, C. T., Kogan, E. V., Mandler, A. G., Yeo, I., Simon, M. S., Kim, L. K., Ip, J. E., Liu, C. F., Markowitz, S. M., Lerman, B. B., Thomas, G., & Cheung, J. W. (2023). Low utilization of lead extraction among patients with infective endocarditis and implanted cardiac electronic devices. Journal of the American College of Cardiology, 81(17), 1714–1725. https://doi.org/10.1016/j.jacc.2023.02.042
