BACKGROUND: Congenital Heart Disease (CHD) predisposes to Infective Endocarditis (IE), but data about characterization and prognosis of IE in CHD patients is scarce. METHODS: The ESC-EORP-EURO-ENDO study is a prospective international study in IE patients (n = 3111). In this pre-specified analysis, adult CHD patients (n = 365, 11.7%) are described and compared with patients without CHD (n = 2746) in terms of baseline characteristics and mortality. RESULTS: CHD patients (73% men, age 44.8 ± 16.6 years) were younger and had fewer comorbidities. Of the CHD patients, 14% had a dental procedure before hospitalization versus 7% in non-CHD patients (p < 0.001) and more often had positive blood cultures for Streptococcus viridans (16.4% vs 8.8%, p < 0.001). As in non-CHD patients, IE most often affected the left-sided valves. For CHD patients, in-hospital mortality was 9.0% vs 18.1% in non-CHD patients (p < 0.001), and also, during the entire follow-up of 700 days, survival was more favorable (log-rank p < 0.0001), even after adjustment for age, gender and major comorbidities (Hazard Ratio (HR) 0.68; 95%CI 0.50-0.92). Within the CHD population, multivariable Cox regression revealed the following effects (HR and [95% CI]) on mortality: fistula (HR 6.97 [3.36-14.47]), cerebral embolus (HR 4.64 [2.08-10.35]), renal insufficiency (HR 3.44 [1.48-8.02]), Staphylococcus aureus as causative agent (HR 2.06 [1.11-3.81]) and failure to undertake surgery when indicated (HR 5.93 [3.15-11.18]). CONCLUSIONS: CHD patients with IE have a better outcome in terms of all-cause mortality. The observed high incidence of dental procedures prior to IE warrants further studies about the current use, need and efficacy of antibiotic prophylaxis in CHD patients.

Amsterdam UMC Vrije Universiteit Amsterdam Cardiology Amsterdam Cardiovascular Sciences the Netherlands

Cardiac Surgery IRCCS San Raffaele University Hospital Milan Italy

Cardiology Department Santa Cruz Hospital Centro Hospitalar de Lisboa Ocidental Lisbon Portugal

Cardiology Department Santa Marta Hospital Centro Hospitalar Universitário Lisboa Central Lisbon Portugal

Center for Congenital Heart Diseases Department of Cardiology University Medical Center Groningen University of Groningen the Netherlands

Department of Cardiology Erasmus MC Rotterdam the Netherlands

Department of Cardiology Kasr Al Ainy Hospital Faculty of Medicine Cairo University Cairo 11562 Egypt

Department of Cardiology Laboratory of Echocardiography Luxembourg Hospital Centre Luxembourg

Department of Cardiovascular Diseases University Hospital Ostrava University of Ostrava Faculty of Medicine Czech Republic

Department of Cardiovascular Diseases University of Zagreb School of Medicine and University Hospital Centre Zagreb Croatia

Echocardiography Research Center Rajaie Cardiovascular Medical and Research Center Tehran Iran; Duke Cardiovascular MR Center Durham NC United States of America

EURObservational Research Programme European Society of Cardiology Heart House 2035 Route des Colles CS80179 Biot 06903 Sophia Antipolis France

Infectious Diseases Unit Cruces University Hospital Barakaldo Spain

La Timone Hospital Cardiology Department Aix Marseille Univ IRD APHM MEPHI IHU Méditerranée Infection Marseille France

Medanta The Medicity Gurgaon Haryana 120001 India

University of Liège Hospital GIGA Cardiovascular Sciences Department of Cardiology CHU Sart Tilman Liège Belgium; Gruppo Villa Maria Care and Research Maria Cecilia Hospital Cotignola Anthea Hospital Bari Italy

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