Abstract 10805: Clinical Predictors of In-Hospital Death and Early Surgery for Infective Endocarditis: CArdiac Disease REgistration, a Nation-Wide Survey in Japan
Introduction: The clinical course of infective endocarditis is highly variable. Moreover, patient characteristics which determine the benefit of early surgery are yet to be elucidated.
Hypothesis: We assessed the hypothesis that early surgery is crucial for prognosis of endocarditis in a nation-wide survey.
Methods: Patients newly admitted for infective endocarditis were registered using a prospective nation-wide WEB-based registration system (CArdiac Disease REgistration, CADRE). Risk factors for in-hospital death were assessed by multiple logistic regression analysis.
Results: From September 2006 to May 2009, 447 endocarditis patients were registered (mean age 60±17 years (range 1–97), men 71%): 348 native valve endocarditis, 89 prosthetic valve endocarditis and 16 pacemaker endocarditis. Streptococcus viridans (32.8%) was the most frequent causative organism, followed by Staphylococcus aureus (21.1%). During the admission, 286 patients (64%) underwent surgery. The factors affecting in-hospital mortality were age older than 60 (odds ratio=2.41 (95% confidence intervals: 1.07–5.44), P=0.034), hemodialysis (6.56 (1.83–23.57), P=0.004), Staphylococcus aureus (2.75 (1.21–6.24), P=0.016), congestive heart failure (7.69 (3.33–16.67), P<0.001) and early surgery (0.09 (0.04–0.22), P<0.001). Early surgery yielded lower in-hospital mortality than medical therapy in the overall population (5.6% vs. 26.1%, P<0.001) as well as in native valve endocarditis (4.1% vs. 26.5%, P<0.001), endocarditis due to Staphylococcus aureus (12.5% vs. 51.4%, P<0.001), patients with chronic disease (10.3% vs. 47.1%, P<0.001), patients complicated with congestive heart failure (9.6% vs. 58.7%, P<0.001) and intracranial complication (4.5% vs. 39%, P<0.001). Of note, in the subgroup without any significant complications (congestive heart failure, new conduction defect, intracranial complication and other vascular embolism) (n=85), in-hospital mortality was low in both early surgery group and medication group (0% vs. 5.1%, P=0.21).
Conclusions: Early surgery for infective endocarditis is warranted for patients with Staphylococcus aureus or complications. Watchful observation with medication may be warranted in an uncomplicated patient.
- © 2010 by American Heart Association, Inc.