The association between vegetation size and surgical treatment on 6-month mortality in left-sided infective endocarditis
Language English Country England, Great Britain Media print
Document type Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't
PubMed
30977784
DOI
10.1093/eurheartj/ehz204
PII: 5449384
Knihovny.cz E-resources
- Keywords
- Antibiotics, Infective endocarditis, Outcomes, Surgery, Vegetation size,
- MeSH
- Survival Analysis MeSH
- Endocarditis, Bacterial microbiology mortality surgery MeSH
- Time Factors MeSH
- Middle Aged MeSH
- Humans MeSH
- Prospective Studies MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
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.
Attikon University General Hospital Athens Greece
Barwon Health and Deakin University Geelong Australia
Cairo University Hospital Cairo Egypt
Central European Institute of Technology Masaryk University Brno Czech Republic
Centre for Cardiovascular Surgery and Transplantation Brno Czech Republic
Department of Cardiology University Hospital of Copenhagen Rigshospitalet Copenhagen Denmark
Duke University Medical Center Durham NC USA
Hadassah Hebrew University Medical Center Jerusalem Israel
Hospital Louis Pradel Lyon Bron France
Infectious Diseases Service Hospital Clinic IDIBAPS University of Barcelona Barcelona Spain
INSERM U 1088 University of Picardie Amiens France
Instituto Cardiovascular de Buenos Aires Buenos Aires Argentina
Instituto Nacional de Cardiologia and Unigranrio Rio de Janeiro Brazil
Internal Medicine University of Campania Monaldi Hospital Naples Italy
Mater Misericordiae University Hospital Dublin Ireland
School of Medicine University of Zagreb Hospital for Infectious Diseases Zagreb Croatia
Servei de MalaltiesInfeccioses Hospital Universitari de Barcelona Barcelona Spain
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