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The association between vegetation size and surgical treatment on 6-month mortality in left-sided infective endocarditis

EL. Fosbøl, LP. Park, VH. Chu, E. Athan, F. Delahaye, T. Freiberger, C. Lamas, JM. Miro, J. Strahilevitz, C. Tribouilloy, E. Durante-Mangoni, JM. Pericas, N. Fernández-Hidalgo, F. Nacinovich, H. Rizk, B. Barsic, E. Giannitsioti, JP. Hurley, MM....

. 2019 ; 40 (27) : 2243-2251. [pub] 20190714

Language English Country Great Britain

Document type Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't

Persistent link   https://www.medvik.cz/link/bmc20028876

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.

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$a Fosbøl, Emil L $u Duke University Medical Center, Durham, NC, USA. Department of Cardiology, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
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$a 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.
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$a Park, Lawrence P $u Duke University Medical Center, Durham, NC, USA.
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$a Strahilevitz, Jacob $u Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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$a Durante-Mangoni, Emanuele $u Internal Medicine, University of Campania, Monaldi Hospital, Naples, Italy.
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$a Fernández-Hidalgo, Nuria $u Servei de MalaltiesInfeccioses, Hospital Universitari de Barcelona, Barcelona, Spain.
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$a Nacinovich, Francisco $u Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.
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$a Rizk, Hussein $u Cairo University Hospital, Cairo, Egypt.
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$a Barsic, Bruno $u School of Medicine University of Zagreb, Hospital for Infectious Diseases, Zagreb, Croatia.
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$a Giannitsioti, Efthymia $u Attikon University General Hospital, Athens, Greece.
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$a Hurley, John P $u Mater Misericordiae University Hospital, Dublin, Ireland.
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$a Hannan, Margaret M $u Mater Misericordiae University Hospital, Dublin, Ireland.
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