Cardiac device endocarditis linked to valve infection, mortality
MedWire News: Patients with cardiac device infective endocarditis (CDIE) are at an increased risk for concomitant valve infection and mortality, a study shows.
And device removal during initial hospitalization is associated with improved survival at 1 year, report Andrew Wang (Duke Hospital, Durham, North Carolina, USA) and colleagues in JAMA.
Wang and team conducted a prospective cohort study using data from the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) between June 2000 and August 2006.
All 2760 patients were hospitalized adults with definite endocarditis as defined by valvular or lead vegetations detected by echocardiography or by meeting the modified Duke endocarditis criteria.
The researchers found that CDIE had been diagnosed in 177 patients of the total cohort of patients with definite infective endocarditis.
The clinical profile of CDIE included advanced patient age (median age 71.2 years), causation by staphylococci, and a higher prevalence of healthcare-associated infection.
Co-existing valve infection was detected in 66 patients, and was associated with a significant three-fold increased risk for in-hospital mortality (p=0.004).
During the index hospitalization, 26 (14.7%) patients with CDIE died, while the mortality rate at 1 year was 23.2%.
Proportional hazards regression analysis showed that patients who had their device removed during the initial hospitalization demonstrated a survival benefit at 1 year. Indeed, 19.9% of those who had their device removed during the initial hospitalization had died at 1 year compared with 38.2% of those who did not.
"Given that numbers of cardiovascular implantable electronic devices placed are increasing rapidly, further studies on the prevention and treatment of this serious complication are needed," conclude the authors.
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By Piriya Mahendra