Predictors of Long-Term Infections After Cardiac Implantable Electronic Device Surgery　― Utility of Novel PADIT and PACE DRAP Scores ―

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Background:Cardiac implantable electronic device-related infections (CDI) are of increasing importance and involve substantial healthcare resources. This study aimed to evaluate potential CDI risk factors and the utility of the novel PADIT and PACE DRAP scores to predict CDI.

Methods and Results:The study group included 1,000 consecutive patients undergoing implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy (CRT) surgery. Patients’ and procedural characteristics were collected. CDI occurrence was assessed during 1-year follow-up. Moreover, if periprocedural significant pocket hematoma (SPH) occurred, the maximal volume was calculated based on ultrasonographic measurements and ABC/2 formula. The overall incidence of CDI was 1.8%. In the multivariable regression analysis independent CDI risk factors were: age >75 years (odds ratio [OR]: 5.93; 95% confidence interval [CI]: 1.77–19.84), system upgrade procedure (OR: 6.46; CI: 1.94–21.44), procedure duration >1 h (OR: 13.96; CI: 4.40–44.25), presence of SPH (OR: 4.95; CI: 1.62–15.13) and reintervention within 1 month (OR: 16.29; CI: 3.14–84.50). The PACE DRAP score had higher discrimination of CDI incidence (area under curve [AUC] 0.72) as compared with the PADIT score (AUC 0.63).

Conclusions:We identified 5 independent risk factors of CDI development. Our study also showed that the PACE DRAP score was better able to identify patients at high risk of CDI than the PADIT score.