Practice patterns and outcomes of cardiac implantable electronic device removal in patients with non-surgically managed infective endocarditis
Main finding · IE readmissionResult — go to the resultHazard ratio 0.39 95% CI 0.19–0.79Authors' conclusion
In this nationwide study of patients with non-surgically managed IE and a CIED, CIED removal was associated with significantly lower 6-month rates of IE readmission, recurrent bacteraemia and mortality compared with no removal, supporting current guideline recommendations. However, randomised clinical trials are warranted to determine the most effective treatment strategy.
Study context
- Population
- Patients aged ≥18 years with first-time infective endocarditis (IE), alive at discharge, managed without valve surgery, with a cardiac implantable electronic device (CIED)patients with non-surgically managed IE and a CIED
- Participants
- 1,040 patients
- Exposure
- Patients who underwent CIED removal during IE admission were compared with those without removal
- Removaln = 596
- Outcome
- IE readmission
- Follow-up
- 6 months after discharge
Methodological detailsDanish nationwide registries (2010-2021), multivariable Cox regression models
- Danish nationwide registries (2010-2021)
- Multivariable Cox regression models
Main finding
As reported in the abstract
Hazard ratio
0.39
95% CI 0.19–0.79
P < 0.001
By group
Removal vs non-removal
HR 0.39 (95% CI 0.19–0.79); P < 0.001
Observational data: associations, not effects.
Further findings
Cumulative incidence
| Outcome | Removal | Non-removal | HR (95% CI) | P value | |
|---|---|---|---|---|---|
| All-cause mortality · 6 months after discharge | 11.5% (95% CI 9.1%–14.3%) | 20.0% (95% CI 16.4%–23.9%) | 0.70 (0.49–0.996) | P < 0.001 | |
| 0.512Hazard ratio (log scale) |
Cumulative incidence
| Outcome | Removal | Non-removal |
|---|---|---|
| Recurrent bacteraemia (including IE with the same microbial aetiology) · 6 months after discharge | 2.1% (95% CI 1.1%–3.5%) | 5.2% (95% CI 3.4%–7.6%) |
- Recurrent bacteraemia (including IE with the same microbial aetiology): p value=0.005
- All-cause mortality: p value from cumulative incidence comparison; HR from multivariable Cox regression
Baseline characteristics
- Patients who underwent removal were younger and less frail than those without removal
Original publication
Practice patterns and outcomes of cardiac implantable electronic device removal in patients with non-surgically managed infective endocarditis. Heart. Published 15 December 2025. doi:10.
Summarised from the published abstract; every number is checked against it