Early detection of cardiac implantable electronic device-related infections reduces mortality: JAMA

CIED infection is a potentially devastating complication. The estimated 12-month mortality associated with this complication is 15% to 30%. The question is, “What is the association of the extent and timing of infection with all-cause mortality?”. This is because the data in this context is limited.

Investigating further the aforementioned background, researchers did a cohort study including 19 559 patients of mean age 68.7 years, 74.6 % male, undergoing cardiac implantable electronic device procedures in 28 centres across Canada and the Netherlands.

The study results could be summarised as follows:

• One hundred seventy-seven patients developed CIED infection.
• Within 3, 6, and 12 months, the cumulative incidence of infection was 0.6%, 0.7%, and 0.9% respectively.
• The infection rate was highest in the first three months, at 0.21% per month and reduced significantly afterwards.
• Those with early localized infections were not at higher risk for all-cause mortality compared with patients who did not develop CIED infection, with an adjusted hazard ratio of 0.64.
• Those with early systemic and delayed localized infections had a 3-fold increase in mortality (8.9% 30-day mortality with aHR, 2.88 and 8.8% 30-day mortality with aHR 3.57 increasing to a 9.3-fold risk of death for those with delayed systemic infections, (21.7% 30-day mortality and aHR of 9.30).

We evaluated the association of the extent and timing of CIED infection with all-cause mortality. We reported that those with early localized infections were not at higher risk of all-cause mortality.

Concluding, those with early systemic infections and delayed localized infections had higher mortality, with the highest risk for patients with delayed systemic infections.

The study has addressed the importance of early detection and treatment of CIED infections in reducing mortality associated with this complication.

Further reading:

Han H, Wang J, Birnie DH, et al. Association of the Timing and Extent of Cardiac Implantable Electronic Device Infections With Mortality. JAMA Cardiol. Published online April 05, 2023. doi:10.1001/jamacardio.2023.0467

early detection and treatment of cardiac implantable electronic device–related infections may be important in reducing associated mortality.