# Investigating the necessity of preoperative coronary angiography for infection-related cardiac implantable electronic device explantation

## TL;DR

This study examines whether preoperative coronary angiography is necessary for patients undergoing cardiac device removal due to infection, finding it does not significantly affect outcomes.

## Contribution

The study provides evidence that routine preoperative coronary angiography may not be essential for CIED explantation in infected cases.

## Key findings

- Preoperative coronary angiography did not significantly affect 30-day mortality in patients with infected cardiac devices.
- There was no significant difference in major postoperative complications between patients who had or did not have preoperative coronary angiography.
- Non-invasive imaging may be increasingly relevant for preoperative evaluation in these cases.

## Abstract

Device-associated endocarditis is a potentially life-threatening condition that typically requires the removal of the cardiac implantable electronic device (CIED). The role of routine coronary angiography (CAG) as part of preoperative evaluation remains uncertain.

This study aims to assess the necessity of preoperative CAG and its impact on clinical outcomes in patients who underwent isolated CIED explantation due to infection.

A single-center retrospective analysis was conducted at Jena University Hospital between 2007 and 2023. The primary outcome was 30-day mortality. The secondary outcomes were major perioperative complications. The data were displayed using descriptive statistics and classic 2-sided tests.

A total of 287 high-risk patients underwent isolated CIED explantation due to infection, of whom 120 underwent a preoperative CAG while 167 did not. Preoperatively, almost the half of the patients did not present history of coronary artery disease (No CAG: 53.9% and CAG: 45.0%), and the CAG group presented higher rates of lead vegetation (65.0% vs 52.7%, p = 0.04). Preoperative CAG had no significant effect on 30-day mortality (9.2% vs 9.6%, p = 1.00, mostly due to sepsis). Additionally, there was no significant difference in postoperative complications between the groups, including myocardial infarction (p = 1.00), bleeding (p = 1.00), acute renal failure (p = 0.76), or surgical conversion (p = 0.29).

The analysis suggests that preoperative CAG does not significantly influence short-term outcomes after CIED explantation due to infection in our patient population. Systematic preoperative CAG may not be necessary for all patients. Moreover, non-invasive imaging modalities may have emerging importance in scenarios like this.