Clinical characteristics, treatment, and outcomes in CIED-related vs. left-sided infective endocarditis: a nationwide study from the NIDUS registry

Cardiac implantable electronic device (CIED)-related infective endocarditis (IE) presents distinct diagnostic and therapeutic challenges due to its unique characteristics and limited evidence supporting guidelines compared with left-sided valvular IE. We aimed to examine clinical characteristics, treatment, and mortality in patients with CIED-related IE vs. left-sided valvular IE.

We included patients with first-time IE using nationwide data from the NatIonal Danish endocarditis StUdieS (NIDUS) registry (2016–2021) and categorized them into isolated CIED-related IE without concomitant valvular IE and left-sided valvular IE. A total of 340 patients with isolated CIED-related IE and 2510 patients with left-sided IE were included. Patients with CIED-related IE vs. left-sided IE were older (76.1 vs. 73.2 years), and a higher proportion were males (78.5% vs. 65.9%), had diabetes (32.9% vs. 21.9%), heart failure (46.2% vs. 11.7%), Staphylococcus aureus (37.1% vs. 30.7%), coagulase-negative staphylococci (11.2% vs. 6.4%), and culture-negative IE (12.1% vs. 7.8%). However, fever at admission was lower in CIED-related IE (55.4% vs. 61.5%). Cardiac implantable electronic device removal was performed in 78.2% of patients with CIED-related IE. The 6-month cumulative incidence of mortality was 20.4% (95% CI: 16.2–24.9%) in CIED-related IE and 26.8% (95% CI: 25.1–28.6%) in left-sided IE (P = 0.009). In a multivariable Cox regression model, CIED-related IE was associated with lower 6-month mortality compared with left-sided IE (adjusted HR: 0.52 [95% CI: 0.40–0.68], P < 0.001).

In this nationwide study, patients with CIED-related IE were distinctly different from those with left-sided IE. Staphylococci were more prevalent, and despite higher age and differences in comorbidities, mortality was lower.