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

Background: 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. Objectives: 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. Methods: 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. Results: 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%, Conclusions: 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.