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Original Articles

Risk Factors for Mortality in Patients With Cardiac Device-Related Infection

Timir S. Baman, MD; Sanjaya K. Gupta, MD; Javier A. Valle, MD and Elina Yamada, MD, FACC, FASE

From the Department of Cardiology, University of Michigan, Ann Arbor.

Correspondence to Elina Yamada, MD, FACC, FASE, Department of Internal Medicine, Cardiovascular Center 2144, 1500 East Medical Center Dr. SPC 5853, Ann Arbor, MI 48109-5853. E-mail elinay{at}umich.edu

Received August 22, 2008; accepted January 7, 2009.

Background— Because of the increased use of pacemakers and implantable cardioverter defibrillators, infection has become a complication with significant morbidity and mortality. Data on risk factors for mortality in patients with cardiac-device related infection are limited. We evaluated the prognostic significance of key clinical and echocardiographic variables in a large retrospective population of patients with cardiac-device related infection.

Methods and Results— Two hundred ten patients with cardiac-device related infection were identified at the University of Michigan between 1995 and 2006. Data were abstracted on key clinical and echocardiographic variables, treatment strategy, and 6-month outcomes. We used multivariable Cox proportional hazards models to examine clinical and echocardiographic variables that were associated with 6-month mortality. Mean age for our study population was 63±17 years, and 72 (44%) were women. All-cause 6-month mortality was 18% (n=37). Independent variables associated with death were systemic embolization (hazard ratio 7.11; 95% CI 2.74 to 18.48), moderate or severe tricuspid regurgitation (hazard ratio 4.24; 95% CI 1.84 to 9.75), abnormal right ventricular function (hazard ratio 3.59; 95% CI 1.57 to 8.24), and abnormal renal function (hazard ratio 2.98; 95% CI 1.17 to 7.59). Size and mobility of cardiac device vegetations were not independently associated with mortality.

Conclusions— We identified several clinical and echocardiographic variables that identify patients with cardiac-device related infection who are at high-risk for mortality and may benefit from more aggressive evaluation.

Key Words: infection • risk factors • mortality • outcome assessment

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CLINICAL PERSPECTIVE

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