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  • Title: Cardiac implantable electronic device and associated risk of infective endocarditis in patients undergoing aortic valve replacement.
    Author: Østergaard L, Valeur N, Bundgaard H, Gislason G, Torp-Pedersen C, Eske Bruun N, Køber L, Fosbøl EL.
    Journal: Europace; 2018 Oct 01; 20(10):e164-e170. PubMed ID: 29294002.
    Abstract:
    AIMS: Patients undergoing aortic valve replacement (AVR) are at increased risk of infective endocarditis (IE) as are patients with a cardiac implantable electronic device (CIED). However, few data exist on the IE risk after AVR surgery in patients with a CIED. METHODS AND RESULTS: Using the Danish administrative registries, we identified patients undergoing AVR from January 1996 to December 2015. Patients were categorized by CIED and non-CIED and followed up till hospitalization due to IE, death, 10 years after AVR discharge, end of study period (December 2015) or emigration, whichever came first. Using multivariable-adjusted Cox proportional hazard analysis with time-varying exposure, we investigated whether CIED was associated with an increased risk of IE. We included 15 538 patients (median age 71.4 years, 25th-75th percentiles 63.7-77.1, and 65.2% male). There were 890 patients with a CIED; 531 of these received their device during the AVR hospitalization and 14 648 patients with no CIED. The crude incidence rate of IE was 149.4/10 000 person-years in the CIED group and 74.3/10 000 person-years in the non-CIED group. Overall, CIED was associated with an increased risk of IE (hazard ratio 1.66, 95% confidence interval 1.27-2.17). There was no difference in associated IE according to the timing of CIED (P for interaction = 0.21 for CIED implantation before vs. in conjunction with AVR surgery). CONCLUSION: Patients with a CIED who underwent surgery for AVR were associated with an increased risk of IE compared with patients without a CIED. The association was independent of the timing of CIED implantation (before or in conjunction with AVR surgery).
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