Michal Pazdernik1,2, Bernard Iung3, Bulent Mutlu4, François Alla5, Robert Riezebos6, William Kong7, Maria Carmo Pereira Nunes8, Luc Pierard9, Ilija Srdanovic10, Hirotsugu Yamada11, Andrea De Martino12, Marcelo Haertel Miglioranza13, Julien Magne14, Cornelia Piper15, Cécile Laroche16, Aldo P Maggioni16,17, Patrizio Lancellotti18, Gilbert Habib19,20, Christine Selton-Suty21,22. 1. Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic. 2. Department of Cardiology, Second Medical School, Charles University, University Hospital Motol, Prague, Czech Republic. 3. Cardiology Department, Bichat Hospital, APHP, Université de Paris, Paris, France. 4. Department of Cardiology, Marmara University Hospital, Pendik, Istanbul, Turkey. 5. CHU de Bordeaux, Bordeaux, France. 6. Heart Center, OLVG, Amsterdam, Netherlands. 7. National University Heart Centre Singapore, Singapore, Singapore. 8. Federal University of Minas Gerais, Belo Horizonte, Brazil. 9. University Hospital Sart Tilman, University of Liege, Liege, Belgium. 10. Medical Faculty University, Novi Sad, Serbia. 11. Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan. 12. University Hospital of Pisa, Pisa, Italy. 13. Brasil Institute of Cardiology/University Foundation, Porto Alegre, Brazil. 14. Cardiology Dept, CHU Limoges, INSERM 1094, University Hospital Dupuytren, 87042, Limoges, France. 15. Herz- und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Bad Oeynhausen, Germany. 16. EURObservational Research Programme, European Society of Cardiology, Biot, France. 17. Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy. 18. University Hospital of Liege (CHU), Liege, Belgium. 19. Cardiology Dept, APHM, La Timone Hospital, Marseille, France. 20. Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France. 21. Cardiology Dept, CIC-ECCHU Nancy-Brabois, 54000, Nancy, France. c.suty-selton@chru-nancy.fr. 22. Association pour l'Etude et la Prevention de l'Endocardite Infectieuse (AEPEI), Paris, France. c.suty-selton@chru-nancy.fr.
Abstract
PURPOSE: High mortality and a limited performance of valvular surgery are typical features of infective endocarditis (IE) in octogenarians, even though surgical treatment is a major determinant of a successful outcome in IE. METHODS: Data from the prospective multicentre ESC EORP EURO-ENDO registry were used to assess the prognostic role of valvular surgery depending on age. RESULTS: As compared to < 80 yo patients, ≥ 80 yo had lower rates of theoretical indication for valvular surgery (49.1% vs. 60.3%, p < 0.001), of surgery performed (37.0% vs. 75.5%, p < 0.001), and a higher in-hospital (25.9% vs. 15.8%, p < 0.001) and 1-year mortality (41.3% vs. 22.2%, p < 0.001). By multivariable analysis, age per se was not predictive of 1-year mortality, but lack of surgical procedures when indicated was strongly predictive (HR 2.98 [2.43-3.66]). By propensity analysis, 304 ≥ 80 yo were matched to 608 < 80 yo patients. Propensity analysis confirmed the lower rate of indication for valvular surgery (51.3% vs. 57.2%, p = 0.031) and of surgery performed (35.3% vs. 68.4%, p < 0.0001) in ≥ 80 yo. Overall mortality remained higher in ≥ 80 yo (in-hospital: HR 1.50[1.06-2.13], p = 0.0210; 1-yr: HR 1.58[1.21-2.05], p = 0.0006), but was not different from that of < 80 yo among those who had surgery (in-hospital: 19.7% vs. 20.0%, p = 0.4236; 1-year: 27.3% vs. 25.5%, p = 0.7176). CONCLUSION: Although mortality rates are consistently higher in ≥ 80 yo patients than in < 80 yo patients in the general population, mortality of surgery in ≥ 80 yo is similar to < 80 yo after matching patients. These results confirm the importance of a better recognition of surgical indication and of an increased performance of surgery in ≥ 80 yo patients.
PURPOSE: High mortality and a limited performance of valvular surgery are typical features of infective endocarditis (IE) in octogenarians, even though surgical treatment is a major determinant of a successful outcome in IE. METHODS: Data from the prospective multicentre ESC EORP EURO-ENDO registry were used to assess the prognostic role of valvular surgery depending on age. RESULTS: As compared to < 80 yo patients, ≥ 80 yo had lower rates of theoretical indication for valvular surgery (49.1% vs. 60.3%, p < 0.001), of surgery performed (37.0% vs. 75.5%, p < 0.001), and a higher in-hospital (25.9% vs. 15.8%, p < 0.001) and 1-year mortality (41.3% vs. 22.2%, p < 0.001). By multivariable analysis, age per se was not predictive of 1-year mortality, but lack of surgical procedures when indicated was strongly predictive (HR 2.98 [2.43-3.66]). By propensity analysis, 304 ≥ 80 yo were matched to 608 < 80 yo patients. Propensity analysis confirmed the lower rate of indication for valvular surgery (51.3% vs. 57.2%, p = 0.031) and of surgery performed (35.3% vs. 68.4%, p < 0.0001) in ≥ 80 yo. Overall mortality remained higher in ≥ 80 yo (in-hospital: HR 1.50[1.06-2.13], p = 0.0210; 1-yr: HR 1.58[1.21-2.05], p = 0.0006), but was not different from that of < 80 yo among those who had surgery (in-hospital: 19.7% vs. 20.0%, p = 0.4236; 1-year: 27.3% vs. 25.5%, p = 0.7176). CONCLUSION: Although mortality rates are consistently higher in ≥ 80 yo patients than in < 80 yo patients in the general population, mortality of surgery in ≥ 80 yo is similar to < 80 yo after matching patients. These results confirm the importance of a better recognition of surgical indication and of an increased performance of surgery in ≥ 80 yo patients.