Abstract 10957: Impact of Early/Late Surgical Treatment on the Outcomes of Patients with Active Infective Endocarditis Complicating Ischemic Stroke
Background: The treatment strategy in active infective endocarditis (IE) with cerebral complications still remains unestablished.
Methods and results: Clinical data were retrospectively reviewed for 244 consecutive patients with active left-sided IE who admitted to our hospital in 1990–2009. In 82 patients with stroke, 67 patients had cerebral infarction including 13 hemorrhagic infarctions, while 15 patients had cerebral bleeding. A mean follow-up period was 5.5 years. Multivariable Cox proportional hazard model showed that cerebral bleeding (HR=4.51; 95% CI 1.60–11.0: p=0.006) but not cerebral infarction was an independent predictor of death. No significant differences were found in mortality between patients with cerebral infarction with and without hemorrhagic infarction. In the 82 patients with stroke, crude survival was significantly better in patients treated by surgery (n=61) than those with conservative treatment (n=21) (87.3% versus 42.4% at 5-year, p<0.001, Figure). Multivariable Cox proportional hazard model subjecting patients with stroke also showed that surgical treatment was significantly associated with lower incidence of mortality (HR=0.18; 95% CI 0.05–0.59: p=0.005). In the 61 patients who underwent surgery, 34 received early surgeries, defined as surgery within 2 weeks after the initial cerebral events, and 27 underwent late surgery at 2 weeks or later. There were no significant differences between the early and the late surgery groups in the incidences of in-hospital death (5.8% versus 7.4%, p=0.81), long-term death (15% versus 11%, p=0.67) and full neurologic recovery: modified Rankin score ≤1 (74% versus 74%, p=0.96). Finally, none of 6 patients with cerebral micro-bleeding who underwent early surgery had secondary cerebral hemorrhagic complications.
Conclusion: Surgical treatment is associated with better outcomes in IE with cerebral complications. Early surgery may be performed as safely as late surgery.
- © 2010 by American Heart Association, Inc.