title: Risk factors for 1-year mortality among patients with cardiac implantable electronic device infection undergoing transvenous lead extraction: the impact of the infection type and the presence of vegetation on survival.
abstract: OBJECTIVE
  Infections of cardiac implantable electronic devices (CIEDs) are infrequent but carry significant morbidity and mortality. We aimed to assess risk factors for 1-year mortality among patients with CIED infection and to evaluate if the type of infection and the presence of vegetation affect survival.
  
  
  RESULTS
  We reviewed records of all patients with infected CIEDs who underwent transvenous lead extraction at our tertiary care centre between 2002 and 2008. Patients who presented with infection involving the device pocket were classified as 'pocket infection', and those who presented with bacteraemia with or without vegetation and a pocket that looked benign were classified as 'endovascular infection' (EVI). One-year mortality was examined using the social security death index. Five hundred and two patients were identified (68.5 ± 15 years); 289 (58%) had pocket infection and 213 (42%) had EVI. One-year mortality rate was 20%. Using multivariable Cox regression model, EVI was associated with significantly higher 1-year mortality (hazard ratio 2.1, P-value 0.0008). Among patients with EVI, 100 patients had vegetation on transoesophageal echo; however, there was no difference in 1-year mortality between patients with EVI and vegetation compared with patients with EVI and no vegetation (27, 27 vs. 40, 35%; P-value 0.188). Risk factors for 1-year mortality among patients with EVI included renal failure, worse functional class, and bleeding requiring transfusion. The presence of vegetation was not associated with increased 1-year mortality.
  
  
  CONCLUSIONS
  One-year mortality is higher among patients with EVI compared with patients with pocket infection; this increased mortality does not seem to be related to the presence of vegetations.
authors.affiliation: Section of Cardiac Pacing and Electrophysiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue/J2-2, Cleveland, OH, Canada 44195 tarakjk@ccf.org.
authors.forename: Khaldoun G
authors.initials: KG
authors.lastname: Tarakji
authors.affiliation: Section of Cardiac Pacing and Electrophysiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue/J2-2, Cleveland, OH, Canada 44195.
authors.forename: Oussama M
authors.initials: OM
authors.lastname: Wazni
authors.affiliation: Section of Cardiac Pacing and Electrophysiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue/J2-2, Cleveland, OH, Canada 44195.
authors.forename: Serge
authors.initials: S
authors.lastname: Harb
authors.affiliation: Section of Cardiac Pacing and Electrophysiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue/J2-2, Cleveland, OH, Canada 44195.
authors.forename: Amy
authors.initials: A
authors.lastname: Hsu
authors.affiliation: Section of Cardiac Pacing and Electrophysiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue/J2-2, Cleveland, OH, Canada 44195.
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
authors.affiliation: Section of Cardiac Pacing and Electrophysiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue/J2-2, Cleveland, OH, Canada 44195.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Wilkoff
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable; D020878:Device Removal; D017548:Echocardiography, Transesophageal; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000401:mortality*; D012307:Risk Factors; D015996:Survival Rate
keywords: CIED; Cardiac implantable electronic device; Complication; Defibrillator; Extraction; Infection; Mortality; Pacemaker