The following is a summary of “Low Utilization of Lead Extraction Among Patients With Infective Endocarditis and Implanted Cardiac Electronic Devices,” published in the May 2023 issue of Cardiology by Sciria, et al.

The cardiac implantable electronic device (CIED)-associated infections pose significant morbidity, mortality, and cost risks. Guidelines strongly recommend transvenous lead removal/extraction (TLE) for patients with CIED-related endocarditis. However, the utilization of TLE in the population and its impact on outcomes remains to be determined. For a study, researchers used a nationally representative database to analyze the utilization of TLE among hospitalized patients with infective endocarditis and CIEDs. The study also aimed to assess the association between TLE and mortality rates.

The researchers utilized the Nationwide Readmissions Database (NRD) to identify 25,303 admissions between 2016 and 2019 for patients with CIEDs and endocarditis, based on International Classification of Diseases-10th Revision, Clinical Modification (ICD-10-CM) codes.

Among the admissions for patients with CIEDs and endocarditis, only 11.5% underwent TLE. Notably, the proportion of patients receiving TLE significantly increased from 7.6% in 2016 to 14.9% in 2019 (P trend < 0.001). Procedural complications were observed in 2.7% of cases. Furthermore, the mortality rate at the index admission was significantly lower among patients managed with TLE than those without TLE (6.0% vs 9.5%, P < 0.001). Several factors were independently associated with TLE management. These included Staphylococcus aureus infection, use of implantable cardioverter-defibrillators, and larger hospital size. Conversely, older age, female sex, dementia, and kidney disease were associated with a lower likelihood of undergoing TLE. After adjusting for comorbidities, TLE was found to be independently associated with significantly lower odds of mortality. The multivariable logistic regression analysis showed an adjusted odds ratio of 0.47 (95% CI: 0.37-0.60), while the propensity score matching analysis yielded an adjusted odds ratio of 0.51 (95% CI: 0.40-0.66).

The utilization of TLE among patients with CIEDs and endocarditis remained low, despite the relatively low rate of procedural complications. However, there has been an increasing trend in the use of TLE from 2016 to 2019. Importantly, TLE was associated with significantly lower mortality rates. Identifying and addressing barriers to TLE for patients with CIEDs and endocarditis was crucial to improve patient outcomes in this high-risk population.

Source: jacc.org/doi/10.1016/j.jacc.2023.02.042