Kim Ju Youn, Park Seung-Jung, Lee Sang Hwa, Seo Gi Hyeon, Jang Sung-Won
Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Dentistry, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Europace. 2022 Dec 9;24(12):1967-1972. doi: 10.1093/europace/euac086.
The incidence of infective endocarditis related to cardiac implantable electronic devices (CIEDs) has gradually increased. The risk associated with dental procedures in patients with CIED implantation and the need for prevention of infective endocarditis remain unclear. The present study investigated the incidence and risk of infective endocarditis associated with invasive dental procedures in patients with CIEDs.
We analysed a nationwide population-based cohort of patients with CIEDs who underwent dental procedures. We performed a self-controlled case series analysis and evaluated the incidence rate ratio of infective endocarditis 3 months after dental procedures. Of a total of 62 019 patients who underwent CIED implantation, 32 536 patients underwent at least one dental procedure during follow-up, and the mean number of dental procedures was 3.4 per patient. They were 152 infections with an incidence of 445 per 100 000 person-years in the dental procedure period and 500 events at an incidence of 255 per 100 000 person-years in the non-dental procedure period. The CIED-related infective endocarditis in the dental procedure period occurred significantly more frequently than during non-dental procedure periods (odds ratio, 1.75; 95% confidence interval, 1.48-2.05; P < 0.001). The mean time interval from dental procedure to infective endocarditis was 59.6 ± 47.3 days.
Invasive dental procedures are associated with an increased risk of infective endocarditis in those who underwent CIED implantation. Appropriate preventive therapy might be needed in these patients.
与心脏植入式电子设备（CIED）相关的感染性心内膜炎发病率逐渐上升。CIED植入患者进行牙科手术的相关风险以及预防感染性心内膜炎的必要性仍不明确。本研究调查了CIED患者侵入性牙科手术相关的感染性心内膜炎的发病率和风险。
我们分析了全国范围内接受牙科手术的CIED患者队列。我们进行了自我对照病例系列分析，并评估了牙科手术后3个月感染性心内膜炎的发病率比。在总共62019例接受CIED植入的患者中，32536例患者在随访期间至少进行了一次牙科手术，每位患者的牙科手术平均次数为3.4次。在牙科手术期间有152例感染，发病率为每10万人年445例，在非牙科手术期间有500例事件，发病率为每10万人年255例。牙科手术期间与CIED相关的感染性心内膜炎的发生频率明显高于非牙科手术期间（优势比，1.75；95%置信区间，1.48 - 2.05；P < 0.001）。从牙科手术到感染性心内膜炎的平均时间间隔为59.6 ± 47.3天。
侵入性牙科手术与CIED植入患者感染性心内膜炎风险增加相关。这些患者可能需要适当的预防性治疗。
