Lauge Østergaard1, Nana Valeur2, Nikolaj Ihlemann1, Henning Bundgaard1, Gunnar Gislason3,4, Christian Torp-Pedersen5,6, Niels Eske Bruun7,8, Lars Søndergaard1, Lars Køber1, Emil Loldrup Fosbøl1. 1. Department of Cardiology, The Heart Centre, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen ø, Denmark. 2. Department of Cardiology, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark. 3. Department of Cardiology, University Hospital Gentofte, Kildegårdsvej 28, 2900 Hellerup, Denmark. 4. Department of Cardiovascular Epidemiology and Research, The Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen K, Denmark. 5. Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 12, 9220 Aalborg, Denmark. 6. Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, Denmark. 7. Clinical Institue, Aalborg University, Sdr. Skovvej 15, 9000 Aalborg, Denmark. 8. Department of cardiology, Herlev-Gentofte Hospital, Kildegaardsvej 28, 2900 Hellerup, Denmark.
Abstract
Aims: Patients with prior infective endocarditis (IE), a prosthetic heart valve, or a cyanotic congenital heart disease (CHD) are considered to be at high risk of IE by guidelines. However, knowledge is sparse on the relative risk of IE between these three groups and compared controls. Methods and results: Using Danish nationwide registries (1996-2015), we identified all patients with prior IE, a prosthetic heart valve, or a complex CHD (defined as tetralogy of Fallot, truncus arteriosus, and transposition of great arteries) as well as matched control populations. Patients were followed up until death, end of study period, IE hospitalization, emigration, or a maximum of 10 years of follow-up, whichever came first. Multivariable adjusted Cox proportional hazard analysis was used to compare the risk of IE between the study groups and the matched controls. We included 25 945 patients: 5096 had prior IE, 19 478 had a prosthetic heart valve, and 1371 had complex CHD. The cumulative risk of IE at 10 years of follow-up was 8.8%, 6.0%, and 1.3% for patients with prior IE, a prosthetic valve, and complex CHD, respectively. Patients with prior IE and a prosthetic valve had a significant increased associated risk of IE compared with the matched controls [hazard ratio (HR) 65.4, 95% confidence interval (CI) 43.1-99.1 and HR 19.1, 95% CI 15.0-24.4), respectively]. No events occurred among the matched controls for the complex CHD group and an HR could not be calculated. Conclusion: All IE high-risk groups carried a higher risk of IE than the matched controls from the general population. These results justify the European and American guidelines in considering these groups at high risk of IE. Published on behalf of the European Society of Cardiology. All rights reserved.
Aims: Patients with prior infective endocarditis (IE), a prosthetic heart valve, or a cyanotic congenital heart disease (CHD) are considered to be at high risk of IE by guidelines. However, knowledge is sparse on the relative risk of IE between these three groups and compared controls. Methods and results: Using Danish nationwide registries (1996-2015), we identified all patients with prior IE, a prosthetic heart valve, or a complex CHD (defined as tetralogy of Fallot, truncus arteriosus, and transposition of great arteries) as well as matched control populations. Patients were followed up until death, end of study period, IE hospitalization, emigration, or a maximum of 10 years of follow-up, whichever came first. Multivariable adjusted Cox proportional hazard analysis was used to compare the risk of IE between the study groups and the matched controls. We included 25 945 patients: 5096 had prior IE, 19 478 had a prosthetic heart valve, and 1371 had complex CHD. The cumulative risk of IE at 10 years of follow-up was 8.8%, 6.0%, and 1.3% for patients with prior IE, a prosthetic valve, and complex CHD, respectively. Patients with prior IE and a prosthetic valve had a significant increased associated risk of IE compared with the matched controls [hazard ratio (HR) 65.4, 95% confidence interval (CI) 43.1-99.1 and HR 19.1, 95% CI 15.0-24.4), respectively]. No events occurred among the matched controls for the complex CHD group and an HR could not be calculated. Conclusion: All IE high-risk groups carried a higher risk of IE than the matched controls from the general population. These results justify the European and American guidelines in considering these groups at high risk of IE. Published on behalf of the European Society of Cardiology. All rights reserved.
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