Ci-452765-4 sex-based differences in transvenous lead extraction management and outcomes among patients with cardiac implantable electronic devices-associated infective endocarditis

Cardiac implantable electronic device (CIED)-associated infections are responsible for substantial morbidity, mortality, and healthcare costs. Although current guidelines recommend complete CIED system removal for patients with infective endocarditis, transvenous lead extraction/removal (TLE) is often underutilized in clinical practice. Numerous studies have reported sex-based disparities in access to various cardiac procedures which may be associated with higher rates of adverse outcomes. To compare TLE utilization and clinical outcomes for females and males with CIEDs hospitalized with infective endocarditis (IE). Using the Nationwide Readmissions Database (NRD), we evaluated 25,303 admissions between 2016-2019 for patients (mean age 71.2, 39.5% female) with prior CIED hospitalized with IE. ICD-10-CM codes were used to identify TLE occurring during index admission. Outcomes of procedural complications, index mortality, early mortality (defined as death during either index admission or readmission), and readmission were analyzed. Overall, TLE was performed in 11.5% of all study patients. Compared to males, females were significantly less likely to undergo TLE (9.3% vs 12.9%; P<0.001). Overall, female patients in the study cohort had a lower proportion of comorbidities such as diabetes mellitus (36.1% vs 39.8%; p<0.001) and kidney disease (38.5% vs 45.8%; p<0.001), but higher rates of dementia (11.4% vs 9.2%; p<0.001) and drug abuse (7.6% vs 5.6%; p<0.001). On multivariable analysis, female sex was associated with a lower odds of TLE (adjusted odds ratio 0.83, 95% CI 0.73-0.95; p=0.005). Females and males had similar rates of TLE-associated procedural complications (3.1% vs 2.5%; respectively; p=0.474). Overall, there were no significant differences in index mortality, early mortality, or 30-day readmissions between females and males with CIEDs-associated IE. Notably, while male patients had a significant reduction in mortality associate with TLE management (5.1% vs. 9.7%; p<0.001), there was no difference in mortality among female patients who underwent TLE when compared to those who did not (7.9% vs. 9.1%; p= 0.383). Female sex is independently associated with lower utilization of TLE for the management of CIED-associated infective endocarditis. Reasons for sex-based disparities in lead extraction for this high-risk patient population need to be further explored.