Department of Medicine, Mayo School of Graduate Medical Education, Rochester, MN, USA.
Europace. 2013 Feb;15(2):227-35. doi: 10.1093/europace/eus292. Epub 2012 Sep 5.
Cardiovascular implantable electronic device (CIED) infection may present as pocket infection or as infective endocarditis (CIED-IE) with vegetation on device leads or heart valves. As aspirin has both anti-inflammatory properties and interferes with platelet aggregation, we hypothesized that ongoing anti-platelet therapy with aspirin may impact clinical and echocardiographic manifestations of CIED infection.
We retrospectively reviewed 415 cases of CIED infection admitted to Mayo Clinic Rochester from 1991 to 2008. Information regarding aspirin use was available in 392 (94.5%) cases and 178 (45%) had received aspirin therapy prior to clinical onset of CIED infection. Although there were no significant differences in pathogen distribution between patients who had received prior aspirin therapy as compared with those who did not, patients on aspirin therapy were less likely to report chills (25% vs. 35%, P = 0.04), sweats (9% vs.18%, P = 0.01), or have peripheral leukocytosis on admission (33% vs. 46%, P = 0.005). Overall, 82 (21%) of 392 patients met the clinical criteria for CIED-IE. Patients on prior aspirin therapy were significantly less likely to have vegetations on CIED leads or heart valves than those who had not received it (15% vs. 26%, P = 0.01). However, despite the lower frequency of CIED-IE in the aspirin group, there was no significant difference (P = 0.97) in the overall survival between the two groups.
Aspirin therapy prior to onset of CIED infection was associated with a lower likelihood of vegetation formation on CIED leads or heart valves and associated systemic manifestations of infection.
心血管植入式电子设备（CIED）感染可表现为口袋感染或感染性心内膜炎（CIED-IE），伴有设备导线或心瓣膜上的赘生物。由于阿司匹林具有抗炎特性并干扰血小板聚集，我们假设持续的抗血小板治疗阿司匹林可能会影响 CIED 感染的临床和超声心动图表现。
我们回顾性分析了 1991 年至 2008 年期间在梅奥诊所罗切斯特分校收治的 415 例 CIED 感染患者。在 392 例（94.5%）患者中可获得阿司匹林使用信息，其中 178 例（45%）在 CIED 感染临床发病前接受过阿司匹林治疗。尽管接受过先前阿司匹林治疗的患者与未接受过治疗的患者之间的病原体分布无显著差异，但接受阿司匹林治疗的患者不太可能报告寒战（25%比 35%，P=0.04）、出汗（9%比 18%，P=0.01）或入院时外周白细胞增多（33%比 46%，P=0.005）。总体而言，392 例患者中有 82 例（21%）符合 CIED-IE 的临床标准。与未接受阿司匹林治疗的患者相比，接受过先前阿司匹林治疗的患者的 CIED 导线上或心瓣膜上发生赘生物的可能性显著降低（15%比 26%，P=0.01）。然而，尽管阿司匹林组的 CIED-IE 发生率较低，但两组之间的总体生存率无显著差异（P=0.97）。
CIED 感染发病前的阿司匹林治疗与 CIED 导线或心瓣膜上赘生物形成以及感染的全身表现的可能性降低相关。
