Clinical Predictors of Cardiovascular Implantable Electronic Device-Related Infective Endocarditis

Background: Cardiovascular implantable electronic device (CIED)‐related infective endocarditis (CIED‐IE) is a serious complication of cardiac device infection and is associated with increased mortality. At present, there exist no criteria to predict CIED‐IE in patients who present with CIED infection. Methods: We retrospectively reviewed all cases of CIED infection seen at Mayo Clinic Rochester between 1991 and 2008. CIED‐IE was classified using pathologic and clinical criteria. Clinical predictors of CIED‐IE were identified using logistic regression, and quantified using a summary score and plotted against the distribution of CIED‐IE. Results: Ninety‐three (22.4%) of the 416 patients with CIED infection had CIED‐IE. Host factors including chronic immunomodulator therapy exclusive of corticosteroid (odds ratio [OR], 3.79 [confidence interval (CI) 1.10, 13.04]), chronic corticosteroid therapy (OR, 2.15 [CI 0.93, 5.00]), hemodialysis (OR, 3.24 [CI 1.39, 7.55]), or remote infection (OR, 1.77 [CI 0.99, 3.14]) were associated with increased odds of CIED‐IE. Patients with CIED‐IE were at increased odds of presenting with fever (OR, 3.78 [CI 1.93, 7.40]), or malaise (OR, 1.87 [CI 1.02, 3.41]), and have findings of leukocytosis (OR, 3.61 [CI 1.51, 8.62]). In marked contrast, they were at decreased odds of exhibiting signs/symptoms of infection at the generator pocket site (OR, 0.19 [CI 0.10, 0.36]). Summary scores of 6 and 11 predicted CIED‐IE in approximately 50% and 90% of cases, respectively. Conclusions: Certain comorbid conditions and systemic manifestations of infection were associated with CIED‐IE. In contrast, pocket site infection was negatively associated with CIED‐IE. These findings should assist clinicians in identifying patients who would more likely benefit from further investigation of CIED‐IE with transesophageal echocardiography. (PACE 2011; 34:450–459)