By Dr Jonathan Shurlock
Edited by Dr Saadia Aslam
The European-Endocarditis registry (Euro-Endo) presents current diagnostic and management practices for infective endocarditis (IE) and associated outcomes based on adherence to ESC IE guidelines 2015.[1] The steering group, led by Professor Erwan Donal (@DonalErwan), have recently published observational data for patients with cardiac device related endocarditis.
This prospective cohort study identified 3116 adult patients from the Euro-Endo registry that met the ESC 2015 IE diagnostic criteria, between January 2016 and March 2018. Of these, 483 patients had a cardiac device.
Three further distinct populations were identified:
| Group | n | Age (±SD) years | % device extraction |
| CDRIE+ LHIE- | 280 | 66.7±14.3 | 62.1% |
| LHIE+ CDRIE- | 157 | 71.1±13.6 | 10.2% |
| CDRIE+ LHIE+ | 46 | 70.2±10.1 | 45.7% |
CDRIE = Cardiac device related infective endocarditis, LHIE = Left heart infective endocarditis.
The most common type of device was a pacemaker (61.7%), followed by defibrillator (24.0%) and CRT-P/D (15.0%). Decision for device extraction was always an IE multi-disciplinary team consensus at each centre.
Overall, in-hospital mortality (regardless of device extraction status) was lower in isolated CDRIE (13.2%) compared with LHIE+CDRIE- (22.3%) and CDRIE+LHIE+ (30.4%), (P = 0.004). Device extraction was associated with reduced mortality [HR 0.59 (0.40–0.87), P = 0.0068]. This association persisted in the LHIE+CDRIE− group (P = 0.047).
Within the limitations of an observational registry database a definite link to causality is difficult to determine. However, this is real world data from 156 centres across 40 countries making the results generalisable to UK cardiology practice.
The use of device extraction as standard of care for individuals with a cardiac device and infective endocarditis may be considered. Future ESC guidelines may recommend device extraction in these cases, with the above caveats.
See the full paper here: https://academic.oup.com/ehjopen/article/3/4/oead064/7217087
References:
[1] Gilbert Habib et al, 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC)
Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM), European Heart Journal, Volume 36, Issue 44, 21 November 2015, Pages 3075–3128, https://doi.org/10.1093/eurheartj/ehv319
