VAD-Related and Specific Infections are Significantly Associated with an Increased Risk of Cerebrovascular Accidents in Patients Supported by a Ventricular Assist Device: An EUROMACS Analysis

PURPOSE: 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 of infections and cerebrovascular accidents (CVAs). METHODS: 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. RESULTS: 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 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. CONCLUSION: Both VAD-related and VAD-specific infections are associated with significant increased risk of CVA, but non-VAD infections are not.

• View at Publisher
• View at Scopus