Influence of early surgical treatment on the prognosis of left-sided infective endocarditis : a multicenter cohort study
Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved..
OBJECTIVE: To analyze the influence of early valve operation on mortality in patients with left-sided infective endocarditis (IE).
PATIENTS AND METHODS: A multicenter cohort study was carried out between 1990 and 2010. Data from consecutive patients with definite IE and possible left-sided IE were collected. Propensity score matching and adjustment for survivor bias were used to control for confounders. The primary outcome was in-hospital mortality.
RESULTS: A total of 1019 patients with a mean age of 61 years (interquartile range, 47-71 years) were included. Early surgical treatment was performed in 417 episodes (40.9%). By propensity score, we matched 316 episodes: 158 who underwent early surgical treatment and 158 who did not (medical treatment group). In-hospital mortality and late mortality were lower in the surgically treated group (26.6% vs 41.8%; absolute risk reduction [ARR], -15.2%; P=.004 and 29.7% vs 46.2%; ARR, -16.5%; P=.002, respectively). Operation was independently associated with a lower risk of in-hospital mortality (odds ratio, 0.42; 95% CI, 0.22-0.79; P=.007). Operation was associated with reduced mortality in patients with paravalvular complications (ARR, -40.5%), severe heart failure (ARR, -32%), and native valve endocarditis (ARR, -17.8%).
CONCLUSION: This study supports the benefit of surgical treatment in patients with left-sided IE carried out during the initial phase of hospitalization, especially in patients with moderate or severe heart failure and paravalvular extension of infection.
| Errataetall: |
CommentIn: Mayo Clin Proc. 2015 Mar;90(3):415-6. - PMID 25744119 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2014 |
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| Erschienen: |
2014 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:89 |
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| Enthalten in: |
Mayo Clinic proceedings - 89(2014), 10 vom: 02. Okt., Seite 1397-405 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Gálvez-Acebal, Juan [VerfasserIn] |
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| Links: |
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| Themen: |
Journal Article |
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| Anmerkungen: |
Date Completed 09.12.2014 Date Revised 22.04.2015 published: Print-Electronic CommentIn: Mayo Clin Proc. 2015 Mar;90(3):415-6. - PMID 25744119 Citation Status MEDLINE |
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| doi: |
10.1016/j.mayocp.2014.06.021 |
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| Förderinstitution / Projekttitel: |
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| 500 | |a CommentIn: Mayo Clin Proc. 2015 Mar;90(3):415-6. - PMID 25744119 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a OBJECTIVE: To analyze the influence of early valve operation on mortality in patients with left-sided infective endocarditis (IE) | ||
| 520 | |a PATIENTS AND METHODS: A multicenter cohort study was carried out between 1990 and 2010. Data from consecutive patients with definite IE and possible left-sided IE were collected. Propensity score matching and adjustment for survivor bias were used to control for confounders. The primary outcome was in-hospital mortality | ||
| 520 | |a RESULTS: A total of 1019 patients with a mean age of 61 years (interquartile range, 47-71 years) were included. Early surgical treatment was performed in 417 episodes (40.9%). By propensity score, we matched 316 episodes: 158 who underwent early surgical treatment and 158 who did not (medical treatment group). In-hospital mortality and late mortality were lower in the surgically treated group (26.6% vs 41.8%; absolute risk reduction [ARR], -15.2%; P=.004 and 29.7% vs 46.2%; ARR, -16.5%; P=.002, respectively). Operation was independently associated with a lower risk of in-hospital mortality (odds ratio, 0.42; 95% CI, 0.22-0.79; P=.007). Operation was associated with reduced mortality in patients with paravalvular complications (ARR, -40.5%), severe heart failure (ARR, -32%), and native valve endocarditis (ARR, -17.8%) | ||
| 520 | |a CONCLUSION: This study supports the benefit of surgical treatment in patients with left-sided IE carried out during the initial phase of hospitalization, especially in patients with moderate or severe heart failure and paravalvular extension of infection | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 700 | 1 | |a Almendro-Delia, Manuel |e verfasserin |4 aut | |
| 700 | 1 | |a Ruiz, Josefa |e verfasserin |4 aut | |
| 700 | 1 | |a de Alarcón, Arístides |e verfasserin |4 aut | |
| 700 | 1 | |a Martínez-Marcos, Francisco J |e verfasserin |4 aut | |
| 700 | 1 | |a Reguera, José M |e verfasserin |4 aut | |
| 700 | 1 | |a Ivanova-Georgieva, Radka |e verfasserin |4 aut | |
| 700 | 1 | |a Noureddine, Mariam |e verfasserin |4 aut | |
| 700 | 1 | |a Plata, Antonio |e verfasserin |4 aut | |
| 700 | 1 | |a Lomas, José M |e verfasserin |4 aut | |
| 700 | 1 | |a de la Torre-Lima, Javier |e verfasserin |4 aut | |
| 700 | 1 | |a Hidalgo-Tenorio, Carmen |e verfasserin |4 aut | |
| 700 | 1 | |a Luque, Rafael |e verfasserin |4 aut | |
| 700 | 1 | |a Rodríguez-Baño, Jesús |e verfasserin |4 aut | |
| 700 | 0 | |a Study Group for Cardiovascular Infections, part of the Andalusian Society of Infectious Diseases |e verfasserin |4 aut | |
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