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					 CLINICAL PREDICTORS OF MORTALITY WITH INTRACARDIAC
     CARDIOVASCULAR ELECTRONIC DEVICE INFECTIONS
 David H. Kim, William Dresen, Michael Baker, Jesalyn A. Tate, Karen Bloch,
     Spyros Kalams, Christopher Ellis, Daniel Lenihan, and Lisa Mendes
                     J. Am. Coll. Cardiol. 2012;59;E712
                    doi:10.1016/S0735-1097(12)60713-X
               This information is current as of April 25, 2012
The online version of this article, along with updated information and services, is
                       located on the World Wide Web at:
       http://content.onlinejacc.org/cgi/content/full/59/13_Suppl_S/E712




                 Downloaded from content.onlinejacc.org by on April 25, 2012
                                                                                                                                              E712
                                                                                                                               JACC March 27, 2012
                                                                                                                                Volume 59, Issue 13


           Arrhythmias
CLINICAL PREDICTORS OF MORTALITY WITH INTRACARDIAC CARDIOVASCULAR ELECTRONIC DEVICE
INFECTIONS

ACC Moderated Poster Contributions
McCormick Place South, Hall A
Monday, March 26, 2012, 11:00 a.m.-Noon


Session Title: ICD Patients: Predictors of SCD/Shock and Lead Management in Infection/Lead Failure
Abstract Category: 18. Arrhythmias: Devices
Presentation Number: 1244-502


Authors: David H. Kim, William Dresen, Michael Baker, Jesalyn A. Tate, Karen Bloch, Spyros Kalams, Christopher Ellis, Daniel Lenihan, Lisa Mendes,
Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA, Division of Infectious Disease, Vanderbilt University
Medical Center, Nashville, TN, USA

Background: The use of cardiovascular implantable electronic devices (CIED) has expanded dramatically over the past decade. Recently, CIED
infections have become an emerging clinical problem. Previous studies included large numbers of patients with generator pocket infection. To date,
no extensive description of risk factors or outcomes related to intracardiac CIED infections has been reported.

Methods: We performed a single center, retrospective study of consecutive patients from July 2006 to February 2011 with intracardiac CIED
infection defined by lead vegetations detected by echocardiography and evidence of ongoing infection or if Duke criteria for endocarditis were met.
Clinical parameters and outcomes were detailed by electronic medical record review and vital status confirmed by the social security death index.

Results: 80 patients (age 66 +/- 14 years, 58 M/22 F) were diagnosed with intracardiac CIED infection. Overall mortality was 36% (median time
to death 95 days), of which >50% (15/29) were infection-related (median time to death 29 days). Important univariate predictors of all cause
mortality are shown in Table 1. Multivariate analysis showed MRSA and concomitant valve endocarditis independently predicted mortality.

Table 1: Risk Factors for Mortality
Clinical Parameter                                All patients, n=80              Survivors, n=51              Non-survivors, n=29
DM                                                30 (38%)                        15 (29%)                     15 (52%)*
HF                                                62 (78%)                        35 (69%)                     27 (93%)*
Peak Cr (mean mg/dL +/- SD)                       2.61 +/- 1.96                   2.19 +/- 1.84                3.32 +/- 1.98*
Indwelling Catheter                               17 (21%)                        8 (16%)                      9 (31%)
MRSA                                              29 (36%)                        11 (22%)                     18 (62%)*
Valve Endocarditis                                33 (41%)                        15 (29%)                     18 (62%)*
Complete Device Extraction                        67 (83.8%)                      44 (86.3%)                   23 (79.3%)
* p<0.05 vs Survivors
DM = Diabetes Mellitus, HF = Heart Failure, Cr = Creatinine, MRSA = methicillin resistant Staphylococcus aureus
Conclusion: In this contemporary series, all cause mortality in patients with intracardiac CIED infection was high with a short time to death from
onset of infection. MRSA and concomitant valve infection were the most powerful, independent predictors of mortality.




                                      Downloaded from content.onlinejacc.org by on April 25, 2012
 CLINICAL PREDICTORS OF MORTALITY WITH INTRACARDIAC
     CARDIOVASCULAR ELECTRONIC DEVICE INFECTIONS
 David H. Kim, William Dresen, Michael Baker, Jesalyn A. Tate, Karen Bloch,
     Spyros Kalams, Christopher Ellis, Daniel Lenihan, and Lisa Mendes
                     J. Am. Coll. Cardiol. 2012;59;E712
                    doi:10.1016/S0735-1097(12)60713-X
                This information is current as of April 25, 2012

Updated Information              including high-resolution figures, can be found at:
& Services                       http://content.onlinejacc.org/cgi/content/full/59/13_Suppl_S/E
                                 712
Rights & Permissions             Information about reproducing this article in parts (figures,
                                 tables) or in its entirety can be found online at:
                                 http://content.onlinejacc.org/misc/permissions.dtl
Reprints                         Information about ordering reprints can be found online:
                                 http://content.onlinejacc.org/misc/reprints.dtl




                  Downloaded from content.onlinejacc.org by on April 25, 2012

				
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