Imberti Jacopo Francesco, Mei Davide Antonio, Fontanesi Riccardo, Gerra Luigi, Bonini Niccolò, Vitolo Marco, Turco Vincenzo, Casali Edoardo, Boriani Giuseppe
Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy.
Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy.
J Clin Med. 2023 Mar 30;12(7):2599. doi: 10.3390/jcm12072599.
The incidence of infections and death in patients implanted with cardiac implantable electronic devices (CIEDs) is not fully known yet.
To describe the incidence of CIED-related infection and death, and their potential predictors in a contemporary cohort of CIED patients.
All consecutive patients implanted with a CIED at our institution were prospectively enrolled. Follow-up visits were performed 2 weeks after CIED implantation for all patients, and then every 6 months for implantable cardioverter defibrillator (ICD)/cardiac resynchronization therapy (CRT) patients and every 12 months for pacemaker (PM) patients. The adjudication of CIED-related infections was performed by two independent investigators and potential disagreement was resolved by a senior investigator.
Between September 2016 and August 2020, a total of 838 patients were enrolled (34.6% female; median age 77 (69.6-83.6); median PADIT score 2 (2-4)). PMs were implanted in 569 (68%) patients and ICD/CRT in 269 (32%) patients. All patients had pre-implant antibiotic prophylaxis and 5.5% had an antibiotic-eluting envelope. Follow-up data were available for 832 (99.2%) patients. After a median follow-up of 42.3 (30.2-56.4) months, five (0.6%) patients had a CIED-related infection and 212 (25.5%) patients died. Using multivariate Cox regression analysis, end-stage chronic kidney disease (CKD) requiring dialysis and therapy with corticosteroids was independently associated with a higher risk of infection (hazard ratio (HR): 14.20; 95% confidence interval (CI) 1.48-136.62 and HR: 14.71; 95% CI 1.53-141.53, respectively). Age (HR: 1.07; 95% CI 1.05-1.09), end-stage CKD requiring dialysis (HR: 6.13; 95% CI 3.38-11.13) and history of atrial fibrillation (HR: 1.47; 95% CI 1.12-1.94) were independently associated with all-cause death.
In a contemporary cohort of CIED patients, mortality was substantially high and associated with clinical factors depicting a population at risk. On the other hand, the incidence of CIED-related infections was low.
心脏植入式电子设备（CIED）植入患者的感染和死亡发生率尚未完全明确。
描述CIED相关感染和死亡的发生率及其在当代CIED患者队列中的潜在预测因素。
前瞻性纳入在我们机构植入CIED的所有连续患者。所有患者在CIED植入后2周进行随访，然后对于植入式心律转复除颤器（ICD）/心脏再同步治疗（CRT）患者每6个月随访一次，对于起搏器（PM）患者每12个月随访一次。CIED相关感染的判定由两名独立研究人员进行，潜在分歧由一名高级研究人员解决。
2016年9月至2020年8月，共纳入838例患者（女性占34.6%；中位年龄77（69.6 - 83.6）岁；中位PADIT评分2（2 - 4））。569例（68%）患者植入了PM，269例（32%）患者植入了ICD/CRT。所有患者植入前均接受抗生素预防，5.5%的患者使用了抗生素洗脱包膜。832例（99.2%）患者有随访数据。中位随访42.3（30.2 - 56.4）个月后，5例（0.6%）患者发生CIED相关感染，212例（25.5%）患者死亡。使用多变量Cox回归分析，需要透析的终末期慢性肾脏病（CKD）和使用皮质类固醇治疗与感染风险较高独立相关（风险比（HR）：14.20；95%置信区间（CI）1.48 - 136.62和HR：14.71；95%CI 1.53 - 141.53）。年龄（HR：1.07；95%CI 1.05 - 1.09）、需要透析的终末期CKD（HR：6.13；95%CI 3.38 - 11.13）和心房颤动病史（HR：1.47；95%CI 1.12 - 1.94）与全因死亡独立相关。
在当代CIED患者队列中，死亡率相当高，且与描述高危人群的临床因素相关。另一方面，CIED相关感染的发生率较低。
