Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Bvld. 99, 8200, Aarhus N, Denmark.
Department of Clinical Medicine, Aarhus University, Palle-Juul Jensens Bvld. 82, 8200, Aarhus N, Denmark.
J Interv Card Electrophysiol. 2023 Jun;66(4):897-904. doi: 10.1007/s10840-022-01236-7. Epub 2022 May 2.
Cardiac surgery in patients with cardiac implantable electronic devices (CIEDs) has been associated with a higher risk of infective endocarditis, but how it influences risk of CIED-specific infections is not known. Our aim was to examine risk of systemic CIED infections after cardiac surgery in patients with CIEDs.
Based on data obtained from Danish administrative registries and the Danish Pacemaker and ICD Register, we conducted a case-control study nested within a nationwide cohort of patients who underwent a de novo CIED implantation in Denmark between 1998 and 2017. We defined cases as incident systemic CIED infections resulting in device system extraction. Controls were sampled 1:100 on time, age, sex and device type using risk set sampling. Exposure was defined as coronary artery bypass graft, or cardiac heart valve replacement or repair surgery.
From a study cohort comprising 67,621 patients, we identified 170 cases and 16,788 controls. In the minimally adjusted model, the incidence rate ratio (IRR) for systemic CIED infection was 6.4 (95% confidence interval (CI) 3.8-10.7) with cardiac surgery, and after additional confounder adjustment, 5.4 (95% CI 3.2-9.2). IRRs were higher with restriction to heart valve replacement surgery (adjusted IRR 7.5, 95% CI 4.0-16.6), and when limiting our exposure time window to one year (adjusted IRR 10.1, 95% CI 4.5-22.3).
Cardiac surgery in patients with de novo CIEDs was associated with a high risk of systemic CIED infections. Highest risk was observed after heart valve replacement surgery and within the first year of surgery.
心脏植入式电子设备 (CIED) 患者的心脏手术与感染性心内膜炎的风险增加相关，但它如何影响 CIED 特定感染的风险尚不清楚。我们的目的是检查接受心脏手术的 CIED 患者发生全身性 CIED 感染的风险。
基于从丹麦行政登记处和丹麦起搏器和 ICD 登记处获得的数据，我们进行了一项病例对照研究，该研究嵌套在丹麦 1998 年至 2017 年间新植入 CIED 的全国性队列患者中。我们将因全身性 CIED 感染导致器械系统取出的病例定义为感染事件。对照组通过风险集抽样按时间、年龄、性别和器械类型 1:100 进行抽样。暴露定义为冠状动脉旁路移植术或心脏心脏瓣膜置换或修复手术。
在一项包含 67621 名患者的研究队列中，我们确定了 170 例病例和 16788 例对照。在最小调整模型中，心脏手术后全身性 CIED 感染的发病率比 (IRR) 为 6.4（95%置信区间 (CI) 3.8-10.7），经过进一步调整混杂因素后，IRR 为 5.4（95%CI 3.2-9.2）。当仅限于心脏瓣膜置换术时，IRR 更高（调整后的 IRR 7.5，95%CI 4.0-16.6），当将我们的暴露时间窗口限制在一年时（调整后的 IRR 10.1，95%CI 4.5-22.3）。
在新植入 CIED 的患者中，心脏手术与全身性 CIED 感染的风险增加相关。在心脏瓣膜置换术后和手术后的第一年风险最高。
