The World-wide Randomized Antibiotic Envelope Infection Prevention (WRAP-IT) trial: Long-term follow-up
Suneet Mittal, Bruce L Wilkoff, Charles Kennergren, Jeanne E Poole, Ralph Corey, Frank A Bracke, Antonio Curnis, Kamel Addo, Joaquin Martinez-Arraras, Ziad F Issa, Calum Redpath, Jean Moubarak, Surinder Kaur Khelae, Lucas V A Boersma, Panagiotis Korantzopoulos, Jo Krueger, Jeff D Lande, Gina M Morss, Swathi Seshadri, Khaldoun G Tarakji, Suneet Mittal, Bruce L Wilkoff, Charles Kennergren, Jeanne E Poole, Ralph Corey, Frank A Bracke, Antonio Curnis, Kamel Addo, Joaquin Martinez-Arraras, Ziad F Issa, Calum Redpath, Jean Moubarak, Surinder Kaur Khelae, Lucas V A Boersma, Panagiotis Korantzopoulos, Jo Krueger, Jeff D Lande, Gina M Morss, Swathi Seshadri, Khaldoun G Tarakji
Abstract
Background: The World-wide Randomized Antibiotic Envelope Infection Prevention trial reported a 40% reduction in major cardiac implantable electronic device (CIED) infections within 12 months of the procedure with the use of an antibacterial-eluting envelope (TYRX Absorbable Antibacterial Envelope, Medtronic, Mounds View, MN).
Objective: The purpose of this report was to describe the longer-term (>12 months) envelope effects on infection reduction and complications.
Methods: All trial patients who underwent CIED replacement, upgrade, revision, or initial cardiac resynchronization therapy - defibrillator implantation received standard-of-care infection prophylaxis and were randomized in a 1:1 ratio to receive the envelope or not. CIED infection incidence and procedure and system-related complications were characterized through all follow-up (36 months) by using Cox proportional hazards regression modeling.
Results: In total, 6800 patients received their intended randomized treatment (3371 envelope; 3429 control; mean follow-up period 21.0 ± 8.3 months). Major CIED-related infections occurred in 32 envelope patients and 51 control patients (Kaplan-Meier [KM] estimate 1.3% vs 1.9%; hazard ratio [HR] 0.64; 95% confidence interval [CI] 0.41-0.99; P = .046). Any CIED-related infection occurred in 57 envelope patients and 84 control patients (KM estimate 2.1% vs 2.8%; HR 0.69; 95% CI 0.49-0.97; P = .030). System- or procedure-related complications occurred in 235 envelope patients and 252 control patients (KM estimate 8.0% vs 8.2%; HR 0.95; 95% CI 0.79-1.13; P < .001 for noninferiority); the most common were lead dislodgment (1.1%), device lead damage (0.5%), and implant site hematoma (0.4%). Implant site pain occurred less frequently in the envelope group (0.1% vs 0.4%; P = .067). There were no (0.0%) reports of allergic reactions to the components of the envelope (mesh, polymer, or antibiotics).
Conclusion: The effects of the TYRX envelope on the reduction of the risk of CIED infection are sustained beyond the first year postprocedure, without an increased risk of complications.
Trial registration: ClinicalTrials.gov NCT02277990.
Keywords: Cardiac resynchronization therapy; Complication; Generator replacement; Implantable cardioverter-defibrillator; Infection; Pacemaker; Replacement.
Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.
Source: PubMed