Cohort study
Low Utilization of Lead Extraction Among Patients With Infective Endocarditis and Implanted Cardiac Electronic Devices
- Retrospective cohort study
- Nationwide Readmissions Database
- propensity score matching
Authors' conclusion
Utilization of lead extraction among patients with CIEDs and endocarditis is low, even in the presence of low rates of procedural complications. Lead extraction management is associated with significantly lower mortality, and its use has trended upward between 2016 and 2019.
Study context
- Population
- Admissions for patients with cardiac implantable electronic device (CIEDs) and infective endocarditis, US, 2016–2019
- Participants
- 25,303 admissions
- Exposure
- TLE vs no TLE
- Outcome
- Utilization of TLE
Main finding
As reported in the abstract
Admissions managed with TLE
Managed with TLE
11.5%
TLE use 2016 vs 2019
7.6% vs 14.9%; P trend < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | TLE | No TLE | adjusted OR (95% CI) | |
|---|---|---|---|---|
| Index mortality · multivariable logistic regression | 6.0% | 9.5% | 0.47 (0.37–0.60) | |
| Index mortality · propensity score matching | 0.51 (0.40–0.66) | |||
| 0.20.5125Adjusted odds ratio (log scale) |
- Index mortality: unadjusted P < 0.001
Factors associated with TLE
- Independently associated with TLE: Staphylococcus aureus infection, ICD, large hospital size
- TLE less likely with older age, female sex, dementia, kidney disease
Safety
Procedural complications
- Procedural complications
- 2.7%
Original publication
Low Utilization of Lead Extraction Among Patients With Infective Endocarditis and Implanted Cardiac Electronic Devices. J Am Coll Cardiol. Published 2 May 2023. doi:10.1016/j.jacc.2023.02.042
Summarised from the published abstract; every number is checked against it