Abstract 3449: Regional Differences in the Clinical Characteristics, Complications and Treatment of Prosthetic Valve Infective Endocarditis: A Global Perspective from the International Collaboration on Endocarditis Prospective Cohort Study
Introduction: Prosthetic valve infective endocarditis (PVIE) is associated with significant morbidity and mortality, but regional differences in PVIE have not been previously evaluated.
Hypothesis: Regional differences in the clinical characteristics and treatment of PVIE are strongly associated with in-hospital mortality.
Methods: In the International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS), 556 patients with definite PVIE were enrolled from 56 centers in 28 countries from 2000–2005.
Regions participating included: North America (10 sites), South America (8 sites), Northern/Central Europe (14 sites), Southern Europe/Middle East/South Africa (11 sites), and Australia/New Zealand/Asia (13 sites). Comparisons of clinical, microbiologic, echocardiographic, treatment and outcome were performed by univariable analysis. Multivariable analysis was performed to determine variables independently associated with in-hospital mortality in PVIE.
Results: Demographic differences in age, diabetes mellitus, and hemodialysis were present across regions (see Table⇓). Although differences were found for staphylococcal infection (both S. aureus and coagulase-negative) and complications of heart failure and persistent bacteremia, the rates of vegetations, intracardiac abscess, and stroke were not statistically different. Use of surgical therapy was common in all regions, and in-hospital mortality rates were high and similar. In multivariable analysis, complications of PVIE were strongly predictive of mortality: stroke (OR 2.0, 1.1–3.6), heart failure (OR 2.3, 1.5–3.4), and persistent bacteremia (OR 4.5, 2.2–9.4).
Conclusions: Differences in clinical characteristics of PVIE across geographic regions, particularly the rate of complicated PVIE, significantly affect the outcome of this disease.