Utility of Novel Padit and Pace Drap Scores As Predictors of Cied Infection Post Implantation In A Tertiary Care Cohort

Sobia Mehreen; Adeel Ahmed; Muhammad Shabbir; Muhammad Ameen; Andaleeb Khan; Muhammad Faheem

doi:10.51253/pafmj.v76iSUPPL-8.13869

Authors

Sobia Mehreen Department of Electrophysiology, Armed Forces Institute of Cardiology Armed Forces Institute of Cardiology/National Institute of Heart Diseases /National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Adeel Ahmed Department of Cardiology, Armed Forces Institute of Cardiology Armed Forces Institute of Cardiology/National Institute of Heart Diseases /National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Muhammad Shabbir Department of Electrophysiology, Armed Forces Institute of Cardiology Armed Forces Institute of Cardiology/National Institute of Heart Diseases /National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Muhammad Ameen Department of Cardiology, Armed Forces Institute of Cardiology Armed Forces Institute of Cardiology/National Institute of Heart Diseases /National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Andaleeb Khan Department of Cardiology, Armed Forces Institute of Cardiology Armed Forces Institute of Cardiology/National Institute of Heart Diseases /National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Dr Muhammad Faheem Department of Cardiology, Armed Forces Institute of Cardiology Armed Forces Institute of Cardiology/National Institute of Heart Diseases /National University of Medical Sciences (NUMS), Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-8.13869

Keywords:

Cardiac implantable electronic device (CIED) infection; and PACE DRAP score, PADIT score

Abstract

Objective: To systematically assess prognostic accuracy and clinical applicability of PADIT score as well as PACE DRAP scores in predicting long-term infectious complications following cardiac implantable electronic device (CIED) procedure.

Study Design: Prospective analytical study

Place and Duration of Study: Electrophysiology department of Armed Forces Institute of Cardiology and National Institute of Heart Diseases at Rawalpindi, Pakistan from Jan 2024 to Jan 2025.

Methodology: The study included 405 patients undergoing cardiac devices implantation. Demographic, clinical and laboratory characteristics were assessed. Patients were categorized in groups based on predetermined criteria in accordance with guidelines.

Results: Overall incidence of cardiac device infection (CDI) was 3.2% (n=13). The PADIT score correlated better with presence of device infections. PADIT score demonstrated better discriminative ability for device infections (AUC of 0.975; 95% CI: 0.941–1.000; p < .001) as compared with PACE DRAP score which showed poor predictive performance for CIED infction (AUC: 0.637; 95% CI: 0.491–0.783; p = .066).

Conclusions: Our study depicted that PADIT score discriminated patients at greater risk for CDI better as compared to PACE DRAP score. Type of procedure including lead revision and system upgrade as well as number of procedures on same pocket increased odds of infection significantly.

Downloads

Download data is not yet available.

References

1 Sławek-Szmyt S, Araszkiewicz A, Grygier M, Szmyt K, Chmielewska-Michalak L, Seniuk W, et al. Predictors of long-term infections after cardiac implantable electronic device surgery: Utility of novel PADIT and PACE DRAP scores. Circulation J 2020; 84(11): 1834–42.

https://doi.org/10.1253/circj.cj-20-0305

2 Asad M, Khan QH, Baloch MW, Khan KA, Naseem MA, Hayat A, et al. Implantable cardiac device infection - a clinical audit. Pak Armed Forces Med J 2021; 70(Suppl-4): S871-875.

3 Blomström-Lundqvist C, Traykov V, Erba PA, Boriani G, Nielsen JC, Bongiorni MG, et al. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections. Europace 2020 ; 22(4): 515-549.

https://doi.org/10.1093/europace/euz246

4 Tarakji KG, Mittal S, Kennergren C, Corey R, Poole JE, Schloss EJ, et al. Antibacterial envelope to prevent cardiac implantable device infection. N Engl J Med 2019; 380(2): 189–199.

https://doi.org/10.1056/nejmoa1901111

5 Płońska-Gościniak E, Olędzki S, Kukulski T, Kosmala W, Młynarski R, Oko-Sarnowska Z, et al. Pol-CDRIE registry: 1-year observational data on patients hospitalized due to cardiac device-related infective endocarditis in Polish referential cardiology centres. Kardiol Pol 2019; 77(5): 561–567. https://doi.org/10.33963/kp.14811

6 Krahn AD, Longtin Y, Philippon F, Birnie DH, Manlucu J, Angaran P, et al. Prevention of arrhythmia device infection trial: The PADIT trial. J Am Coll Cardiol 2018 ; 72(24): 3098-3109

https://doi.org/10.1016/j.jacc.2018.09.068

7 Rennert-May E, Chew D, Lu S, Chu A, Kuriachan V, Somayaji R. Epidemiology of cardiac implantable electronic device infections in the United States: a population-based cohort study. Heart Rhythm 2020; 17 (7): 1125-31.

https://doi.org/10.1016/j.hrthm.2020.02.012

8 Sławek-Szmyt S, Araszkiewicz A, Grygier M, Szmyt K, Seniuk W, Waśniewski M et al. PACE DRAP: a simple score for predicting significant bleeding complications after cardiac implantable electronic device surgery. Pol Arch Intern Med 2020; 130(3): 206-215.

https://doi.org/10.20452/pamw.15180

9 Olsen T, Jørgensen OD, Nielsen JC, Thøgersen AM, Philbert BT, Frausing MH, et al. Risk factors for cardiac implantable electronic device infections: a nationwide Danish study. Eur. Heart J 2022; 43(47): 4946-4956.

https://doi.org/10.1093/eurheartj/ehac576

10 Baddour LM, Garrigos ZE, Sohail MR, Havers-Borgersen E, Krahn AD, Chu VH, et al. Update on Cardiovascular Implantable Electronic Device Infections and Their Prevention, Diagnosis, and Management: A Scientific Statement from the American Heart Association. Circulation J 2024; 149(2): e201–e216.

https://doi.org/10.1161/cir.0000000000001187

11 Olsen T, Jørgensen OD, Nielsen JC, Thøgersen AM, Philbert BT, Johansen JB. Incidence of device-related infection in 97750 patients: Clinical data from the complete Danish device-cohort (1982–2018). Eur Heart J 2019; 40(23): 1862-1869

https://doi.org/10.1093/eurheartj/ehz316

12 De Heide J, van der Graaf M, Holl MJ, Hoogendijk MG, Bhagwandien RE, Wijchers SA, et al. Device infection in patients undergoing pacemaker or defibrillator surgery: risk stratification using the PADIT score. J Interv Card Electrophysiol 2024; 67(6): 1419-1426. https://doi.org/10.1007/s10840-024-01759-1

13 Rennert-May E, Chew D, Lu S, Chu A, Kuriachan V, Somayaji R. Epidemiology of cardiac implantable electronic device infections in the United States: A population-based cohort study. Heart Rhythm 2020 ; 17(7): 1125-1131

https://doi.org/10.1016/j.hrthm.2020.02.012

14 Kubra G, Irfan G, Abbas SG, Aamir KF, Baloch MW, Abdul Mueed. Cardiac Implantable Electronic Device (CIED) Infections, Associated Risk Factors and Optimization in Reducing CIED Infections; an Experience of Tertiary Care Hospital of Pakistan. Pak Armed Forces Med J 2024; 74(1): 49-53.

15 Birnie DH, Wang J, Alings M, Philippon F, Parkash R, Manlucu J, et al. Risk factors for infections involving cardiac implanted electronic devices. J Am Coll Cardiol 2019; 74(23): 2845-2854.

https://doi.org/10.1016/j.jacc.2019.09.060

16 Essebag V, Verma A, Healey JS, Krahn AD, Kalfon E, Coutu B, et al. Clinically significant pocket hematoma increases long-term risk of device infection: BRUISE CONTROL INFECTION study. J Am Coll Cardiol 2016 Mar 22; 67(11): 1300-1308

https://doi.org/10.1016/j.jacc.2016.01.009

17 Essebag V, Healey JS, Joza J, Nery PB, Kalfon E, Leiria TLL, et al. Effect of Direct Oral Anticoagulants, Warfarin, and Antiplatelet Agents on Risk of Device Pocket Hematoma: Combined Analysis of BRUISE CONTROL 1 and 2. Circ Arrhythm Electrophysiol 2019 ; 12(10): e007545.

https://doi.org/10.1161/circep.119.007545

18 Nazir F, Nazir MTB, Khan QH, Javed MU. The Assessing the Effectiveness of the PADIT Score in Predicting CIED Infections: Insights from a Tertiary Care Center. Pak Heart J 2025 ; 58(1): 59-64.

19 Malagù M, Donazzan L. (Risk Scores for Cardiac Implantable Electronic Device Infection: Which One to Believe In? J Clin Med 2022 ; 11(21): 6556

https://doi.org/10.3390/jcm11216556

20 Ishiguchi H, Ishikura M, Yoshida M, Imoto K, Sonoyama K, Kawabata T, et al. Incidence and risk factors for cardiac implantable electronic device infection in current clinical settings in a Japanese population: A 20-year single-center observational study. J Cardiol 2020; 76(1): 115-122

https://doi.org/10.1016/j.jjcc.2020.01.006

21 Traykov V, Blomström-Lundqvist C. Antibiotic-eluting envelopes for the prevention of cardiac implantable electronic device infections: rationale, efficacy, and cost-effectiveness. Front Cardiovasc Med 2022; 9: 855233.

https://doi.org/10.3389/fcvm.2022.855233

22 Tarakji KG, Krahn AD, Poole JE, Mittal S, Kennergren C, Biffi M, et al. Risk factors for CIED infection after secondary procedures: insights from the WRAP-IT trial. JACC Clin Electrophysiol 2022; 8(1): 101-111.

https://doi.org/10.1016/j.jacep.2021.08.009

23 Tarakji KG, Korantzopoulos P, Philippon, Biffi M ,Mittal S,Poole JE : Infectious consequences of hematoma from cardiac implantable electronic device procedures and the role of the antibiotic envelope: a WRAP-IT trial analysis. Heart Rhythm 2021; 18(12): 2080–2086.

https://doi.org/10.1016/j.hrthm.2021.07.011

24 Boriani G, Vitolo M, Wright DJ, Biffi M, Brown B, Tarakji KG, et al:Infections associated with cardiac electronic implantable devices: economic perspectives and impact of the TYRX™ antibacterial envelope. Europace 2021; 23(4): iv33-iv44

https://doi.org/10.1093/europace/euab126