Emil L Fosbøl1,2, Lawrence P Park1, Vivian H Chu1, Eugene Athan3, Francois Delahaye4, Tomas Freiberger5,6, Cristiane Lamas7, Jose M Miro8, Jacob Strahilevitz9, Christophe Tribouilloy10,11, Emanuele Durante-Mangoni12, Juan M Pericas8, Nuria Fernández-Hidalgo13, Francisco Nacinovich14, Hussein Rizk15, Bruno Barsic16, Efthymia Giannitsioti17, John P Hurley18, Margaret M Hannan18, Andrew Wang1. 1. Duke University Medical Center, Durham, NC, USA. 2. Department of Cardiology, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark. 3. Barwon Health and Deakin University, Geelong, Australia. 4. Hospital Louis Pradel, Lyon-Bron, France. 5. Centre for Cardiovascular Surgery and Transplantation, Brno, Czech Republic. 6. Central European Institute of Technology, Masaryk University, Brno, Czech Republic. 7. Instituto Nacional de Cardiologia and Unigranrio, Rio de Janeiro, Brazil. 8. Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain. 9. Hadassah-Hebrew University Medical Center, Jerusalem, Israel. 10. University Hospital, Amiens, France. 11. INSERM U-1088, University of Picardie, Amiens, France. 12. Internal Medicine, University of Campania, Monaldi Hospital, Naples, Italy. 13. Servei de MalaltiesInfeccioses, Hospital Universitari de Barcelona, Barcelona, Spain. 14. Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina. 15. Cairo University Hospital, Cairo, Egypt. 16. School of Medicine University of Zagreb, Hospital for Infectious Diseases, Zagreb, Croatia. 17. Attikon University General Hospital, Athens, Greece. 18. Mater Misericordiae University Hospital, Dublin, Ireland.
Abstract
AIMS: In left-sided infective endocarditis (IE), a large vegetation >10 mm is associated with higher mortality, yet it is unknown whether surgery during the acute phase opposed to medical therapy is associated with improved survival. We assessed the association between surgery and 6-month mortality as related to vegetation size. METHODS AND RESULTS: Patients with definite, left-sided IE (2008-2012) from The International Collaboration on Endocarditis prospective, multinational registry were included. We compared clinical characteristics and 6-month mortality (by Cox regression with inverse propensity of treatment weighting) between patients with vegetation size ≤10 mm vs. >10 mm in maximum length by surgical treatment strategy. A total of 1006 patients with left sided IE were included; 422 with a vegetation size ≤10 mm (median age 66.0 years, 33% women) and 584 (median age 58.4 years, 34% women) patients with a large vegetation >10 mm. Operative risk by STS-IE score was similar between groups. Embolic events occurred in 28.4% vs. 44.3% (P < 0.001), respectively. Patients with a vegetation >10 mm was associated with higher 6-month mortality (25.1% vs. 19.4% for small vegetation, P = 0.035). However, after propensity adjustment, the association with higher mortality persisted only in patients with a large vegetation >10 mm vs. ≤10 mm: hazard ratio (HR) 1.55 (1.27-1.90); but only in patients with large vegetation managed medically [HR 1.86 (1.48-2.34)] rather than surgically [HR 1.01 (0.69-1.49)]. CONCLUSION: Left-sided IE with vegetation size >10 mm was associated with an increased mortality at 6 months in this observational study but was dependent on treatment strategy. For patients with large vegetation undergoing surgical treatment, survival was similar to patients with smaller vegetation size. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: In left-sided infective endocarditis (IE), a large vegetation >10 mm is associated with higher mortality, yet it is unknown whether surgery during the acute phase opposed to medical therapy is associated with improved survival. We assessed the association between surgery and 6-month mortality as related to vegetation size. METHODS AND RESULTS:Patients with definite, left-sided IE (2008-2012) from The International Collaboration on Endocarditis prospective, multinational registry were included. We compared clinical characteristics and 6-month mortality (by Cox regression with inverse propensity of treatment weighting) between patients with vegetation size ≤10 mm vs. >10 mm in maximum length by surgical treatment strategy. A total of 1006 patients with left sided IE were included; 422 with a vegetation size ≤10 mm (median age 66.0 years, 33% women) and 584 (median age 58.4 years, 34% women) patients with a large vegetation >10 mm. Operative risk by STS-IE score was similar between groups. Embolic events occurred in 28.4% vs. 44.3% (P < 0.001), respectively. Patients with a vegetation >10 mm was associated with higher 6-month mortality (25.1% vs. 19.4% for small vegetation, P = 0.035). However, after propensity adjustment, the association with higher mortality persisted only in patients with a large vegetation >10 mm vs. ≤10 mm: hazard ratio (HR) 1.55 (1.27-1.90); but only in patients with large vegetation managed medically [HR 1.86 (1.48-2.34)] rather than surgically [HR 1.01 (0.69-1.49)]. CONCLUSION: Left-sided IE with vegetation size >10 mm was associated with an increased mortality at 6 months in this observational study but was dependent on treatment strategy. For patients with large vegetation undergoing surgical treatment, survival was similar to patients with smaller vegetation size. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Mario Pérez-Sayáns; José R González-Juanatey; Alejandro I Lorenzo-Pouso; Cintia M Chamorro-Petronacci; Andrés Blanco-Carrión; Xabier Marichalar-Mendía; José M Somoza-Martín; Juan A Suárez-Quintanilla Journal: Odontology Date: 2021-01-11 Impact factor: 2.634