Impact of hospital lead extraction volume on management of cardiac implantable electronic device-associated infective endocarditis.

IF 7.9 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Europace Pub Date : 2024-12-26 DOI:10.1093/europace/euae308

Ari G Mandler, Christopher T Sciria, Edward V Kogan, Ilya Kim, Ilhwan Yeo, Matthew S Simon, Luke K Kim, James E Ip, Christopher F Liu, Steven M Markowitz, Bruce B Lerman, George Thomas, Jim W Cheung

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Abstract

Aims: Utilization of transvenous lead extraction/removal (TLE) for the management of cardiac implantable electronic device (CIED)-associated infective endocarditis (IE) remains low. The aim of this study was to examine the impact of hospital TLE procedural volume on TLE utilization and outcomes for patients with CIED-associated IE.

Methods and results: Using the Nationwide Readmissions Database, we evaluated 21 545 admissions for patients (mean age 70 years, 39% female) with CIEDs hospitalized with IE at TLE centres. Hospitals were categorized based on annual volume tertiles: (i) low-volume (1-17 TLEs/year), (ii) medium-volume (18-45 TLEs/year), and (iii) high-volume centres (>45 TLEs/year). Between 2016 and 2019, 57% of admissions in the study were to low-volume TLE centres. Transvenous lead extraction/removal was performed during 6.9, 19.3, and 26% of admissions for CIED-associated IE at low-, medium-, and high-volume TLE centres, respectively (P < 0.001). After adjustment for age and comorbidities, hospitalization for IE at high-volume centres was independently associated with TLE when compared with low-volume centres (adjusted odds ratio 4.26; 95% confidence interval 3.53-5.15). Transvenous lead extraction/removal-associated complication rates were similar at 2.5, 2.3, and 3.4% at low-, medium-, and high-volume centres, respectively (P = 0.493). Overall inpatient mortality during admissions to low-, medium-, and high-volume centres was also similar.

Conclusion: Admissions to high-volume TLE centres were associated with higher utilization of TLE for management of CIED-associated IE. Transvenous lead extraction/removal-associated complications and mortality among patients hospitalized with CIED-associated IE were similar when stratified by hospital TLE volume, but this needs to be considered in context of significant differences in patient comorbidity burden between centres.

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医院拔铅量对心脏植入式电子设备相关感染性心内膜炎处理的影响

背景：经静脉铅提取/去除（TLE）治疗心脏植入式电子设备（CIED）相关感染性心内膜炎（IE）的使用率仍然很低。目的：探讨医院TLE手术量对cied相关IE患者TLE利用及预后的影响。方法：使用全国再入院数据库，我们评估了21,545例在TLE中心因IE住院的cied患者（平均年龄70岁，39%为女性）。医院根据年业务量进行分类：1)低业务量（1-17 TLEs/年）2)中等业务量（18-45 TLEs/年）和3)高业务量中心（bbb45 TLEs/年）。结果：2016年至2019年期间，该研究中57%的入院者是小容量TLE中心。在低、中、高容量TLE中心，与cied相关的IE入院患者中，分别有6.9%、19.3%和26%进行了TLE （P< 0.001）。在调整了年龄和合并症后，与小容量中心相比，在大容量中心因IE住院与TLE独立相关(aOR 4.26；95% ci 3.53-5.15)。低、中、高中心的TLE拔管相关并发症发生率相似，分别为2.5%、2.3%和3.4% （P = 0.493）。在低容量、中容量和高容量中心住院期间的总体住院死亡率也相似。结论：高容量TLE中心的入院与TLE治疗cied相关IE的较高利用率相关。当按医院TLE容量分层时，cied相关IE住院患者的TLE相关并发症和死亡率相似，但需要考虑各中心患者合并症负担的显着差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Europace 医学-心血管系统

CiteScore

10.30

自引率

8.20%

发文量

851

审稿时长

3-6 weeks

期刊介绍： EP - Europace - European Journal of Pacing, Arrhythmias and Cardiac Electrophysiology of the European Heart Rhythm Association of the European Society of Cardiology. The journal aims to provide an avenue of communication of top quality European and international original scientific work and reviews in the fields of Arrhythmias, Pacing and Cellular Electrophysiology. The Journal offers the reader a collection of contemporary original peer-reviewed papers, invited papers and editorial comments together with book reviews and correspondence.