TY - JOUR
T1 - Incidence of device-related infection in 97750 patients
T2 - clinical data from the complete Danish device-cohort (1982-2018)
AU - Olsen, Thomas
AU - Jørgensen, Ole Dan
AU - Nielsen, Jens Cosedis
AU - Thøgersen, Anna Margrethe
AU - Philbert, Berit Thornvig
AU - Johansen, Jens Brock
N1 - © The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2019/6/14
Y1 - 2019/6/14
N2 - Aims Device-related infection (DRI) is a severe complication to cardiac implantable electronic devices (CIED) therapy. Device-related infection incidence and its risk factors differ between previous studies. We aimed to define the long-term incidence and incidence rates of DRI for different types of CIEDs in the complete Danish device-cohort and identify patient-, operation- and device-related risk factors for DRI. Methods From the Danish Pacemaker (PM) and implantable cardioverter-defibrillator (ICD) Register, we included consecu- and results tive Danish patients undergoing CIED implantation or reoperation from January 1982 to April 2018, resulting in 97 750 patients, 128 045 operations and follow-up of in total 566 275 device years (DY). We identified 1827 DRI causing device removals. Device-related infection incidence during device lifetime was 1.19% (1.12–1.26) for PM, 1.91% (1.71–2.13) for ICD, 2.18% (1.78–2.64) for cardiac resynchronization therapy (CRT)-pacemakers (CRT-P), and 3.35% (2.92–3.83) for CRT-defibrillators (CRT-D). Incidence rates in de novo implantations were 2.04/1000 DY for PM, 3.84 for ICD, 4.38 for CRT-P, and 6.76 for CRT-D. Using multiple-record and multiple-event per subject proportional hazard analysis, we identified implantation of complex devices (ICD and CRT), reoperations, prior DRI, male sex, and younger age as significantly associated with higher DRI risk. Conclusion Overall risk of infection was low in PM implantations but considerably higher in CRT systems and after reinterven-tions. These data support the importance of evaluating all patients considered for CIED therapy thoroughly, in order to identify potential modifiable risk factors and reduce the risk of early reoperations.
AB - Aims Device-related infection (DRI) is a severe complication to cardiac implantable electronic devices (CIED) therapy. Device-related infection incidence and its risk factors differ between previous studies. We aimed to define the long-term incidence and incidence rates of DRI for different types of CIEDs in the complete Danish device-cohort and identify patient-, operation- and device-related risk factors for DRI. Methods From the Danish Pacemaker (PM) and implantable cardioverter-defibrillator (ICD) Register, we included consecu- and results tive Danish patients undergoing CIED implantation or reoperation from January 1982 to April 2018, resulting in 97 750 patients, 128 045 operations and follow-up of in total 566 275 device years (DY). We identified 1827 DRI causing device removals. Device-related infection incidence during device lifetime was 1.19% (1.12–1.26) for PM, 1.91% (1.71–2.13) for ICD, 2.18% (1.78–2.64) for cardiac resynchronization therapy (CRT)-pacemakers (CRT-P), and 3.35% (2.92–3.83) for CRT-defibrillators (CRT-D). Incidence rates in de novo implantations were 2.04/1000 DY for PM, 3.84 for ICD, 4.38 for CRT-P, and 6.76 for CRT-D. Using multiple-record and multiple-event per subject proportional hazard analysis, we identified implantation of complex devices (ICD and CRT), reoperations, prior DRI, male sex, and younger age as significantly associated with higher DRI risk. Conclusion Overall risk of infection was low in PM implantations but considerably higher in CRT systems and after reinterven-tions. These data support the importance of evaluating all patients considered for CIED therapy thoroughly, in order to identify potential modifiable risk factors and reduce the risk of early reoperations.
KW - CIED
KW - CRT
KW - Device
KW - ICD
KW - Incidence
KW - Infection
KW - Pacemaker
UR - http://www.scopus.com/inward/record.url?scp=85068197317&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/ehz316
DO - 10.1093/eurheartj/ehz316
M3 - Review article
C2 - 31155647
SN - 0195-668X
VL - 40
SP - 1862
EP - 1869
JO - European Heart Journal
JF - European Heart Journal
IS - 23
ER -