Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
Victorian Heart Institute, Monash University, Clayton, Victoria, Australia.
JAMA Cardiol. 2023 May 1;8(5):484-491. doi: 10.1001/jamacardio.2023.0467.
Cardiac implantable electronic device (CIED) infection is a potentially devastating complication with an estimated 12-month mortality of 15% to 30%. The association of the extent (localized or systemic) and timing of infection with all-cause mortality has not been established.
To evaluate the association of the extent and timing of CIED infection with all-cause mortality.
DESIGN, SETTING, AND PARTICIPANTS: This prospective observational cohort study was conducted between December 1, 2012, and September 30, 2016, in 28 centers across Canada and the Netherlands. The study included 19 559 patients undergoing CIED procedures, 177 of whom developed an infection. Data were analyzed from April 5, 2021, to January 14, 2023.
Prospectively identified CIED infections.
Time-dependent analysis of the timing (early [≤3 months] or delayed [3-12 months]) and extent (localized or systemic) of infection was performed to determine the risk of all-cause mortality associated with CIED infections.
Of 19 559 patients undergoing CIED procedures, 177 developed a CIED infection. The mean (SD) age was 68.7 (12.7) years, and 132 patients were male (74.6%). The cumulative incidence of infection was 0.6%, 0.7%, and 0.9% within 3, 6, and 12 months, respectively. Infection rates were highest in the first 3 months (0.21% per month), reducing significantly thereafter. Compared with patients who did not develop CIED infection, those with early localized infections were not at higher risk for all-cause mortality (no deaths at 30 days [0 of 74 patients]: adjusted hazard ratio [aHR], 0.64 [95% CI, 0.20-1.98]; P = .43). However, patients with early systemic and delayed localized infections had an approximately 3-fold increase in mortality (8.9% 30-day mortality [4 of 45 patients]: aHR, 2.88 [95% CI, 1.48-5.61]; P = .002; 8.8% 30-day mortality [3 of 34 patients]: aHR, 3.57 [95% CI, 1.33-9.57]; P = .01), increasing to a 9.3-fold risk of death for those with delayed systemic infections (21.7% 30-day mortality [5 of 23 patients]: aHR, 9.30 [95% CI, 3.82-22.65]; P < .001).
Findings suggest that CIED infections are most common within 3 months after the procedure. Early systemic infections and delayed localized infections are associated with increased mortality, with the highest risk for patients with delayed systemic infections. Early detection and treatment of CIED infections may be important in reducing mortality associated with this complication.
心脏植入式电子设备 (CIED) 感染是一种潜在的破坏性并发症，估计在 12 个月时的死亡率为 15%至 30%。感染的范围（局部或全身）和时间与全因死亡率之间的关联尚未确定。
评估 CIED 感染的范围和时间与全因死亡率之间的关联。
设计、设置和参与者：这是一项在 2012 年 12 月 1 日至 2016 年 9 月 30 日期间在加拿大和荷兰的 28 个中心进行的前瞻性观察性队列研究。该研究纳入了 19559 名接受 CIED 手术的患者，其中 177 名发生了感染。数据分析于 2021 年 4 月 5 日至 2023 年 1 月 14 日进行。
前瞻性确定的 CIED 感染。
对感染的时间（早期[≤3 个月]或延迟[3-12 个月]）和范围（局部或全身）进行时间依赖性分析，以确定与 CIED 感染相关的全因死亡率风险。
在接受 CIED 手术的 19559 名患者中，有 177 名患者发生了 CIED 感染。患者的平均（标准差）年龄为 68.7（12.7）岁，有 132 名男性（74.6%）。感染的累积发生率分别为 3 个月、6 个月和 12 个月时的 0.6%、0.7%和 0.9%。在前 3 个月感染率最高（每月 0.21%），此后显著降低。与未发生 CIED 感染的患者相比，发生早期局部感染的患者全因死亡率没有更高的风险（30 天内无死亡[74 例患者中 0 例]：校正后危险比[aHR]，0.64[95%CI，0.20-1.98]；P = .43）。然而，发生早期全身感染和延迟局部感染的患者死亡率增加了约 3 倍（30 天死亡率为 8.9%[45 例患者中 4 例]：aHR，2.88[95%CI，1.48-5.61]；P = .002；30 天死亡率为 8.8%[34 例患者中 3 例]：aHR，3.57[95%CI，1.33-9.57]；P = .01），而发生延迟全身感染的患者死亡风险增加了 9.3 倍（30 天死亡率为 21.7%[23 例患者中 5 例]：aHR，9.30[95%CI，3.82-22.65]；P < .001）。
研究结果表明，CIED 感染在手术后 3 个月内最常见。早期全身感染和延迟局部感染与死亡率增加相关，而延迟全身感染患者的风险最高。早期发现和治疗 CIED 感染可能对降低与该并发症相关的死亡率很重要。
