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(1) Background: Management of cardiac implantable electronic device-related infective endocarditis (CIED-IE) hinges on complete hardware removal. We assessed whether long-term prognosis is affected by device removal, considering baseline patient comorbid conditions; (2) Methods: A total of 125 consecutive patients hospitalized for CIED-IE were included in this retrospective analysis. Outcomes were in-hospital, one-year, and long-term mortality. There were 109 patients who underwent device removal, 91 by transvenous lead extraction (TLE) and 18 by open heart surgery (OHS); (3) Results: TLE translated into lower hospital mortality (4.4% vs. 22.5% with OHS; p = 0.03). Septic pulmonary embolism was the only independent predictor of in-hospital mortality (OR:7.38 [1.49-36.6], p = 0.013). One-year mortality was in contrast independently associated to tricuspid valve involvement ( p = 0.01) and Charlson comorbidity index (CCI, p = 0.039), but not the hardware removal modality. After a median follow-up of 41 months, mortality rose to 24%, and was significantly influenced only by CCI. Specifically, patients with a higher CCI who were also treated with TLE showed a survival rate not significantly different from those managed with medical therapy only; (4) Conclusions: In CIED-IE, TLE is the strategy of choice for hardware removal, improving early outcomes. Long-term benefits of TLE are lessened by comorbidities. In cases of CIED-IE with high CCI, a more conservative approach might be an option.

(1) Background: The aim of this study was to assess the clinical significance and prognostic role of the main hemostasis parameters in infective endocarditis (IE): prothrombin time as international normalized ratio (PT-INR), activated partial thromboplastin time (aPTT), fibrinogen, D-dimers, platelet count, homocysteine. (2) Methods: We studied 337 patients with IE. Clinical, hemato-chemical and echocardiography parameters were analyzed. Coagulation parameters were measured on admission. (3) Results: D-dimers levels ( p = 0.012) and a prolonged PT-INR ( p = 0.013) were associated with higher in-hospital mortality, while prolonged aPTT ( p = 0.021) was associated with increased 1-year mortality. Staphylococcus aureus ( S. aureus ) infection ( p = 0.003), prosthetic valve endocarditis (PVE) ( p = 0.001), surgical indication ( p = 0.002) and higher D-dimer levels ( p = 0.005) were independent predictors of in-hospital mortality. PVE ( p = 0.001), a higher Charlson Comorbidity Index ( p = 0.049), surgical indication ( p = 0.001) and prolonged aPTT ( p = 0.012) were independent predictors of 1-year mortality. Higher levels of D-dimers ( p < 0.001) and a shorter aPTT ( p < 0.001) were associated with embolic complications of IE. S. aureus etiology was bound to higher D-dimers levels ( p < 0.001) and a shorter aPTT ( p = 0.006). (4) Conclusions: Elevated D-dimers are associated with a higher risk for in-hospital mortality in IE patients. High D-dimers and a short aPTT are associated with a higher risk for embolic events in IE. A longer aPTT is associated with 1-year mortality.