title: Lead-related infective endocarditis: Factors influencing early and long-term survival in patients undergoing transvenous lead extraction.
abstract: Lead-related infective endocarditis (LRIE) is a serious infectious disease with uncertain prognosis.
  
  
  
  The purpose of this study was to evaluate the factors that influence survival in patients with LRIE undergoing transvenous lead extraction (TLE).
  
  
  
  Clinical data obtained from 500 consecutive patients with LRIE undergoing TLE in the reference center in the years 2006 to 2015 were retrospectively analyzed. We evaluated the effect of demographic, clinical, and procedure-related factors on 30-day and long-term survival (mean 3-year follow-up).
  
  
  
  Analysis of 30-day survival after TLE revealed 19 deaths (3.8%), with long-term mortality (mean 3-year follow-up) of 29.3% (146 deaths). Multivariate analysis showed unfavorable effects of age (hazard ratio [HR] 1.056, 95% confidence interval [CI] 1.030-1.082); decreased left ventricular ejection fraction (HR 0.687, 95% CI 0.545-0.866); renal failure (HR 3.099, 95% CI 1.865-5.150); and presence of vegetation fragments remaining after TLE (HR 1.384, 95% CI 1.089-1.760). Log-rank test and Kaplan-Meier survival curves demonstrated statistically worse prognosis in patients with large vegetations (>2 cm) and with vegetation remnants. Better prognosis was associated with LRIE coexisting with generator pocket infection.
  
  
  
  Long-term mortality in LRIE patients is still high. Factors that influence negatively on prognosis include large cardiac vegetations and their remnants after TLE. Such vegetations develop most frequently in patients with decreased left ventricular ejection fraction and renal failure. Probably, early detection of LRIE would tend to limit the formation of large vegetations that invade the adjacent cardiac structures.
authors.affiliation: Department of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland; 2nd Department of Cardiology, Swietokrzyskie Cardiology Center, Kielce, Poland. Electronic address: annapolewczyk@wp.pl.
authors.forename: Anna
authors.initials: A
authors.lastname: Polewczyk
authors.affiliation: 2nd Department of Cardiology, Silesian Medical University, Zabrze, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Jacheć
authors.affiliation: Department of Cardiology, Medical University, Lublin, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Tomaszewski
authors.affiliation: Department of Cardiology, Medical University, Lublin, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Brzozowski
authors.affiliation: Department of Cardiac Surgery, Medical University, Lublin, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Czajkowski
authors.affiliation: 1st Department of Cardiology, Medical University of Warsaw, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Opolski
authors.affiliation: 1st Department of Cardiology, Medical University of Warsaw, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Grabowski
authors.affiliation: Department of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland; 2nd Department of Cardiology, Swietokrzyskie Cardiology Center, Kielce, Poland.
authors.forename: Marianna
authors.initials: M
authors.lastname: Janion
authors.affiliation: Department of Cardiology, Medical University, Lublin, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kutarski
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000601:surgery; D015331:Cohort Studies; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal; D004567:Electrodes, Implanted / Q000009:adverse effects; D004696:Endocarditis / Q000209:etiology* / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016459:Prosthesis-Related Infections / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D035583:Rare Diseases; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Generator pocket infection; Lead-related infective endocarditis; Prognosis; Transvenous lead extraction; Vegetation remnants