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VAD related infections and the risk of pump thrombosis and thromboembolic events: a EUROMACS study


 
 
 In patients supported by a ventricular assist device (VAD) major infections are a frequently reported adverse event with increased morbidity and mortality.
 
 
 
 The purpose of this study was to investigate the possible association between infections and cerebrovascular accidents (CVAs) in VAD patients.
 
 
 
 An analysis of the European Registry for Patients Assisted with Mechanical Circulatory Support (EUROMACS) was performed identifying all patients aged ≥18 years with a LVAD or BiVAD implantation. Infections were categorized as VAD-specific infections, VAD-related infections and, non-VAD infections. An extended Kaplan-Meier analysis for the risk of CVA and mortality with infection as a time-dependent covariate was performed. Furthermore, a multivariable Cox proportional hazard model was performed including 24 variables.
 
 
 
 For this analysis 3784 patients were included, with 45 patients being supported by a BiVAD and 3739 by an LVAD. The majority of patients were male (83.2%) and 60.5% had an INTERMACS patient profile 2 or 3. During follow-up, 3108 major infections were identified in 1385 (36.6%) of the patients, while 673 CVAs were identified in 545 (14.4%) of the patients. Extended Kaplan-Meier analysis with first infection as time-dependent covariate revealed a hazard ratio (HR) for CVA of 1.95 (95% CI: 1.57–2.36; p<0.005) (Figure) and 1.50 (95% CI: 1.33–1.68, p<0.005) for mortality. Multivariable analysis confirmed a significant association for infection and CVAs with a HR of 1.46 (95% CI: 1.29–1.64). With infections subcategorized, VAD-specific (HR: 1.57 (95% CI: 1.18–2.09)) and VAD-related infections (HR: 2.04 (95% CI: 1.44–2.89)) remained significantly associated with CVA but non-VAD infections (HR: 1.22 (95% CI: 0.92–1.64)) were not.
 
 
 
 Both VAD-related and VAD-specific infections are associated with a significantly increased risk of CVA with increased risk of mortality.
 
 
 
 Type of funding sources: None. KM freedom of CVA and infection
