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August 22/29, 2012

Cardiac Device Infective Endocarditis and Patient Survival—Reply

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliations: Department of Infectious Diseases, Barwon Health, Geelong, Australia (Dr Athan); and Duke University Medical Center, Durham, North Carolina (Dr Wang; a.wang@duke.edu).

JAMA. 2012;308(8):761. doi:10.1001/jama.2012.9246

In Reply: Drs Wu and Yang have raised the question of means of device removal in the setting of CDIE, in addition to the results presented regarding any device removal vs no removal. Unfortunately, our case report forms did not collect this information from site investigators, although ICE-PCS (International Collaboration on Endocarditis-Prospective Cohort Study) sites were predominantly referral centers.1 Similarly, procedural complications directly associated with device removal, including mortality, were not collected. However, in our study, in-hospital mortality was all cause, including both procedure-related mortality as well as other causes of death. Specifically, death related to sepsis or comorbid medical conditions in this population of patients with advanced age and multiple medical problems may be independent from the device removal procedure itself. As shown in a recent study of consecutive device removal procedures,2 patients with systemic infection as the indication for device removal had significantly higher mortality in both short-term and longer-term follow-up. We agree that operator and institutional experience and volume in device and lead removal is critical for optimal outcome in these cases.

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