on February 13, 2009
Published online before print February 13, 2009, doi: 10.1161/CIRCEP.108.816868
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Original Article |
Risk Factors for Mortality in Patients with Cardiac Device-Related Infection
University of Michigan
1 E-mail: timir{at}med.umich.edu
Background—Due to the increased utilization of pacemakers and implantable cardioverter defibrillators (ICDs), infection has become a complication with significant morbidity and mortality. Data on risk factors for mortality in patients with cardiac-device related infection (CDI) are limited. We evaluated the prognostic significance of key clinical and echocardiographic variables in a large retrospective population of patients with CDI.
Methods and Results—Two hundred ten patients with CDI were identified at the University of Michigan between 1995 and 2006. Data were abstracted on key clinical and echocardiographic variables, treatment strategy, and six-month outcomes. We used multivariable Cox proportional hazards models to examine clinical and echocardiographic variables that were associated with six-month mortality. Mean age for our study population was 63±17 years and 72 (44%) were women. All-cause six-month mortality was 18% (n=37). Independent variables associated with death were systemic embolization (HR 7.11; 95% CI 2.74 to 18.48), moderate or severe tricuspid regurgitation (HR 4.24; 95% CI 1.84 to 9.75), abnormal right ventricular function (HR 3.59; 95% CI 1.57 to 8.24), and abnormal renal function (HR 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 CDI who are at high-risk for mortality and may benefit from more aggressive evaluation.
Key Words: infection • mortality • risk factors • cardiac device • outcomes research
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