April 25th, 2012
Study Sheds Light on Cardiac Device Infective Endocarditis
A new study sheds light on a rare but highly dangerous complication associated with device implants: cardiac device infective endocarditis (CDIE). Approximately 10% to 23% of device infections result in CDIE, leading, in one estimate, to an overall rate of 1.14 cases per 1000 device-years.
In a paper published in JAMA, Eugene Athan and colleagues analyzed data from 3284 patients who were enrolled in the International Collaboration on Endocarditis–Prospective Cohort Study (ICE-PCS). Among patients with a definite diagnosis of infective endocarditis (IE), 6.4% had CDIE. Mortality rates were high:
- in-hospital mortality: 14.7%, CI, 9.8%-20.8%
- 1-year mortality: 23.2%, CI 17.2%-30.1%
Compared with other IE patients, CDIE patients were more likely to be male, older, and diabetic. Staphylococci infections accounted for most of the cases. Coexisting valve infection occurred in more than a third of the cases, and these patients were more likely to die. Patients who had the device removed during the initial hospitalization had a lower 1-year mortality rate than those who did not have the device removed (19.9% vs. 38.2%, HR 0.42, CI 0.22- 0.82).