AIMS: Cardiac device-related infective endocarditis (CDRIE) is a severe complication of cardiac device (CD) implantation and is usually treated by antibiotic therapy and percutaneous device extraction. Few studies report the management and prognosis of CDRIE in real life. In particular, the rate of device extraction in clinical practice and the management of patients with left heart infective endocarditis (LHIE) and an apparently non-infected CD (LHIE+CDRIE-) are not well described. METHODS AND RESULTS: We sought to study in EURO-ENDO, the characteristics, prognosis, and management of 483 patients with a CD included in the European Society of Cardiology EurObservational Research Programme EURO-ENDO registry. Three populations were compared: 280 isolated CDRIE (66.7 ± 14.3 years), 157 patients with LHIE and an apparently non-infected CD (LHIE+CDRIE-) (71.1 ± 13.6), and 46 patients with both LHIE and CDRIE (LHIE+CDRIE+) (70.2 ± 10.1). Echocardiography was not always transoesophageal echography (TOE); it was transthoracic echography (TTE) for isolated CDRIE in 88.4% (TOE = 67.6%), for LHIE+CDRIE- TTE = 93.0% (TOE = 58.6%), and for CDRIE+LHIE+ TTE = 87.0% (TOE = 63.0%). Nuclear imaging was performed in 135 patients (positive for 75.6%). In-hospital mortality was lower in isolated CDRIE 13.2% vs. 22.3% and 30.4% for LHIE+CDRIE- and LHIE+CDRIE+ (P = 0004). Device extraction was performed in 62.1% patients with isolated CDRIE, 10.2% of LHIE+CDRIE- patients, and 45.7% of CDRIE+LHIE+ patients. Device extraction was associated with a better prognosis [hazard ratio 0.59 (0.40-0.87), P = 0.0068] even in the LHIE+CDRIE- group (P = 0.047). CONCLUSION: Prognosis of endocarditis in patients with a CD remains poor, particularly in the presence of an associated LHIE. Although recommended by guidelines, device extraction is not always performed. Device removal was associated with better prognosis, even in the LHIE+CDRIE- group.

APHM Cardiology Department La Timone Hospital Marseille France

Cardiac Surgery Innovation and Research 'Vita Salute' San Raffaele University Hospital Milan 20132 Italy

Cardiologie CHU de RENNES LTSI UMR1099 INSERM Université de Rennes 1 hopital pontchaillou 35000 Rennes France

Clinical Center of Serbia Clinic of Cardiology Belgrade Serbia

Departamento de Cardiologia Hospital Garcia de Orta Almada Portugal

Department of Cardiology Amiens University Hospital Amiens Amiens 80000 France

Department of Cardiology Asan Medical Center University of Ulsan College of Medicine 388 1 Poongnap dong Songpa gu Seoul 138 736 Korea

Department of Cardiology Gruppo Villa Maria Care and Research Anthea Hospital Bari Italy

Department of Cardiology Heart Valve Clinic GIGA Cardiovascular Sciences CHU Sart Tilman University of Liege Hospital Liege Belgium

Department of Cardiology Kings College Hospital and King's College London Denmark Hill London SE5 9RS UK

Department of Cardiology Polyclinic of Bari Hospital Bari 70124 Italy

Department of Cardiology RUDN Univerisity Moscow Russia

Department of Cardiology University Hospital Brno Jihlavska 20 Brno 62500 Czech Republic

Department of Cardiovascular Medicine Kobe City Medical Center General Hospital Kobe Japan

Echocardiography Research Centre Rajaie Cardiovascular Medical and Research Centre Iran University of Medical Sciences Tehran Iran

European Society of Cardiology EORP Sophia Antipolis France

F CRIN INI CRCT Cardiovascular and Renal Clinical Trialists Network INSERM 1116 CHRU de Nancy Nancy France

Infectious Diseases Service Hospital Clinic IDIBAPS University of Barcelona Barcelona Spain

IRD APHM MEPHI IHU Méditerranée Infection Aix Marseille University Marseille France

Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde Hospital das Clínicas da Universidade Federal de Minas Gerais Belo Horizonte MG Brazil

servico de Echocardiografia InRad HC Faculdade de Medicina Universidade de Sao Paulo SP Brazil

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