Risk factors for infection of implantable cardiac devices: data from a registry of 2496 patients.

AIMS: The increased use of implantable cardiac devices has been accompanied by an increase in infection. However, risk factors for infection of implanted devices are poorly documented. We aimed to identify risk factors in patients with long-term follow-up after implantation of cardiac devices. METHODS AND RESULTS: Patients with first implantation of a cardiac device in our centre between October 1996 and July 2007 were entered in a registry. Each confirmed infection of the implanted device was matched to two controls for age, sex, and implantation year. We recorded cardiovascular risk factors (hypertension, diabetes), previous history of heart disease, renal failure, antiplatelet or anticoagulant therapy, as well as pre- and post-procedural characteristics (antibiotic prophylaxis, hyperthermia, number of leads, associated interventions, and early complications). During the study period, 2496 patients underwent implantation of a cardiac device; 35 infections were diagnosed (1.2%). Among these, 75% occurred during the first year after implantation. Early non-infectious complication requiring surgical intervention was observed only in patients with infection (9 of 35, P < 0.001). Factors independently associated with infection were diabetes [odds ratio (OR) 3.5, 95% confidence interval (CI) [1.03, 12.97]], underlying heart disease (OR 3.12, 95% CI [1.13; 8.69]), and use of >1 lead (OR 4.07, 95% CI [1.23, 13.47]). These latter two risk factors were also independently associated with occurrence of infection within 1 year of implantation. CONCLUSION: Our data show that the presence of diabetes and underlying heart disease are independent risk factors for infection after cardiac device implantation. As regards procedural characteristics, the use of several leads and early re-intervention are associated with a higher infection rate.

Cardiovascular prognosis at 1-year of patients with acute coronary syndrome is related to abdominal aortic aneurysm despite small size of the aneurysm.

BACKGROUND: Global cardiovascular (CV) risk associated with abdominal aortic aneurysms (AAAs) has been poorly documented. The aim of this study was to evaluate whether the presence of AAA in patients hospitalized for acute coronary syndrome with coronary stenosis (≥50%) was associated with an increased CV risk at 1-year follow-up. METHODS: Between February 1, 2008 and March 30, 2009, 304 patients admitted for acute coronary syndrome with significant (≥50% stenosis) coronary lesions underwent echocardiography to check for presence of AAA. Twenty AAAs were diagnosed, of average (±standard deviation) diameter 33 ± 3.7 mm. Follow-up at 1 year was available for 288 patients (95%). Variables recorded at 1 year were death, cause of death, and occurrence of nonfatal CV events of cardiac or peripheral vascular origin. RESULTS: During follow-up, 65 patients (22.6%) experienced an event (all-cause death or nonfatal CV event), including 21 deaths (7.3%) and 44 nonfatal CV events (15.3%). The presence of AAA significantly increased the risk of any CV event (fatal or nonfatal) at 1 year (hazard ratio: 2.96, 95% CI: 1.49-5.89, p = 0.002) but did not influence overall mortality or CV mortality. CONCLUSION: Our results show that in patients with coronary artery disease already at high CV risk, the presence of AAA was associated with worse CV prognosis at 1 year, and incurred an increased risk of occurrence of any CV event (fatal and nonfatal).

Prevalence of abdominal aortic aneurysm and large infrarenal aorta in patients with acute coronary syndrome and proven coronary stenosis: a prospective monocenter study.

BACKGROUND: Little is known about the prevalence of abdominal aortic aneurysm (AAA) in patients with coronary heart disease. The aims of this prospective study were to evaluate the prevalence of AAA and of large abdominal aorta in patients hospitalized for acute coronary syndrome and coronary stenosis of 50% or greater. METHODS: AAA ultrasound screening was prospectively performed in 306 patients after they gave informed consent. AAA and large abdominal aorta were defined by maximum anteroposterior diameter of 30 mm or greater and of 20 to 29 mm, respectively. Patient characteristics were prospectively collected. Univariate and multivariate analyses were used to identify risk factors for AAA and large abdominal aorta. A p value <0.05 was considered statistically significant. RESULTS: AAAs were diagnosed in 20 patients (6.6%). Mean diameter was 33 +/- 3.7 mm, and median diameter [min--max] was 31 mm [30 - 45 mm]. All except one AAA were between 30 and 40 mm. No AAAs were detected in patients younger than 50 years. Prevalence reached 7.7% in patients older than 50 years. Using stepwise logistic regression analysis, age (odds ratio [OR] 1.04. 95% confidence [CI] 1.00-1.09 per year of age, p = 0.06) and previous coronary events (OR 2.44, 95% CI 0.96-6.25, p = 0.06) showed a borderline significant association with AAA. Large infrarenal aortic diameter was observed in 32% of patients. Age (OR 1.03, 95% CI 1.02-1.05 per year of age, p < 0.0001), male gender (OR 16.7, 95% CI 6.25-50.0, p < 0.0001), and overweight (OR 2.0, 95% CI 1.2-3.4, p = 0.01) showed a significant independent association with large aorta. CONCLUSION: AAA and large infrarenal aorta prevalence seems high in patients with acute coronary syndrome and proven coronary stenosis of 50% or greater. Previous coronary events and older age might be associated with higher risk of AAA, and age, male gender, and obesity are significantly associated with large infrarenal aorta. If these results are confirmed in larger studies, further guidelines concerning AAA screening in this well-defined population should be considered.

[Digital arterial embolization from a previously thrombosed arteriovenous access: a rare and misdiagnosed complication]. / Ischémie digitale par embolie à partir d'un abord d'hémodialyse thrombosé: une complication rare à ne pas méconnaître.

Surgical removal of a hemodialysis access after thrombosis is generally not performed as it remains clinically well tolerated. However, it may be the source of distal embolization. We report the case of a 43-year-old patient, kidney recipient, who presented with digital ischemia of the right hand. He had a forearm arteriovenous fistula at the right wrist which thrombosed 5 years ago. Digital ischemia was due to thrombus formation at the anastomotic site and migration into the downstream arterial bed. Heparine was initiated together with antiplatelet treatment. The ischemia resolved after a few days, no recidive was observed. Surgical ligation of the arteriovenous fistula was rapidly performed and antiplatelet treatment was maintained after surgery. After a follow-up of 6 months, the patient remained asymptomatic without new embolization. This observation underlines the necessity of clinical monitoring after access thrombosis and preventive surgical ligation might be discussed when the risk of distal embolization is high.