Division of Cardiology, University of California-San Diego, La Jolla, California, USA.
Division of Cardiology, University of California-San Diego, La Jolla, California, USA.
JACC Clin Electrophysiol. 2021 Jun;7(6):755-763. doi: 10.1016/j.jacep.2020.11.003. Epub 2020 Dec 24.
This study sought to assess the impact of early versus delayed lead extraction in patients with an infected cardiovascular implantable electronic device (CIED).
CIED infections are associated with poor outcomes. Prior studies have demonstrated improved survival with CIED extraction compared with antibiotic therapy alone. The impact of timing of CIED extraction has not been well characterized.
All infected CIED extraction cases at our medical center from 2006 to 2019 were reviewed. Patients were divided into 2 groups based on the presence of bacteremia or isolated pocket infection. We assessed the in-hospital morbidity and 1-year mortality for early versus delayed lead extraction, using hospitalization day 7 as cutoff.
Of 233 patients who underwent CIED extraction, 127 patients had bacteremia and 106 patients had pocket infection. Delayed extraction (15.2 days) in bacteremic patients was associated with septic shock (odds ratio [OR]: 5.39; 95% confidence interval [CI]: 1.23 to 23.67; p = 0.026), acute kidney injury (OR: 5.61; 95% CI: 2.15 to 14.63; p < 0.001), respiratory failure (OR: 5.52; 95% CI: 1.25 to 24.41; p = 0.024), and decompensated heart failure (OR: 3.32; 95% CI: 1.10 to 10.05; p = 0.033). Locally infected patients with delayed extraction (10.7 days) were associated with acute kidney injury (OR: 3.45; 95% CI: 1.11 to 10.77; p = 0.033) and respiratory failure (OR: 10.29; 95% CI: 1.26 to 83.93; p = 0.030). Delayed CIED extraction in both groups was associated with increased 1-year mortality.
Delayed infected CIED extraction is associated with worse outcomes. This underscores the importance of early detection and a strategy for prompt management including lead extraction.
本研究旨在评估感染性心血管植入式电子设备（CIED）患者早期与延迟拔除电极的影响。
CIED 感染与不良结局相关。先前的研究表明，与单独使用抗生素治疗相比，CIED 拔除可提高生存率。CIED 拔除时机的影响尚未得到很好的描述。
回顾了 2006 年至 2019 年期间我院所有感染性 CIED 拔除病例。根据是否存在菌血症或单纯的囊袋感染，将患者分为两组。我们使用住院第 7 天作为截断值，评估了早期与延迟拔除电极的住院期间发病率和 1 年死亡率。
在 233 例行 CIED 拔除的患者中，127 例患者有菌血症，106 例患者有囊袋感染。菌血症患者的延迟拔除（15.2 天）与感染性休克（优势比 [OR]：5.39；95%置信区间 [CI]：1.23 至 23.67；p=0.026）、急性肾损伤（OR：5.61；95%CI：2.15 至 14.63；p<0.001）、呼吸衰竭（OR：5.52；95%CI：1.25 至 24.41；p=0.024）和失代偿性心力衰竭（OR：3.32；95%CI：1.10 至 10.05；p=0.033）相关。延迟拔除的局部感染患者（10.7 天）与急性肾损伤（OR：3.45；95%CI：1.11 至 10.77；p=0.033）和呼吸衰竭（OR：10.29；95%CI：1.26 至 83.93；p=0.030）相关。两组中延迟的 CIED 拔除均与 1 年死亡率增加相关。
延迟的感染性 CIED 拔除与更差的结局相关。这强调了早期发现和及时管理策略（包括电极拔除）的重要性。
