Abstract 15601: Indications, Clinical Profile and Outcome of Patients with Infective Endocarditis Undergoing Early Surgery. Data from the Italian Registry of Infective Endocarditis (RIEI)
The aim of this study was to describe the profile and the outcome of patients with infective endocarditis (IE) who underwent early (before the planned antibiotic treatment has ended) surgery in a real world practice. The Italian Registry of Infective Endocarditis collected data from 680 consecutive patients with definite IE who were admitted to 16 Italian hospitals from August 2006 through August 2010. The mean age of the cohort was 61 ± 16 years, and 80% had left-sided IE (31% aortic valve, 31% mitral valve, 18% prosthetic valve). The choice of early surgery or conventional treatment was at the discretion of attending physicians. Early surgery was performed in 380 cases (56%). In-hospital mortality was 14%: 6% in the group treated surgically, and 8% among patients treated medically. Indications for early surgery included: vegetations at risk of embolization (256 cases, 67%) heart failure (149 cases, 39%), paravalvular complications (78 cases, 13%), and persistent infection (41 cases, 11%). The table shows the comparative mortality between patients with surgical indications according to treatment. On multivariate analysis age > 65 years (odds ratio, 2.35; 95% confidence interval, 1.38- 4.02), chronic kidney disease (3.03; 1.64-5.58), heart failure (4.50; 1.74-11.63), paraprosthetic complications (3.31; 1.98- 5.52), persistent infection (4.49; 1.01-19.8) were independently associated with an increased risk of in-hospital death, whereas early surgery (0.21; 0.10-0.43) was associated with a decreased risk. The incidence of systemic embolism was lower in patients undergoing early surgery (3% vs 19%; p<0.001), which resulted independently associated with reduced embolic risk (0.24; 0.18-0.69) on a multivariate analysis. In conclusion early surgery is associated with improved clinical outcomes by effectively decreasing mortality and systemic embolism in patients with IE.
- © 2012 by American Heart Association, Inc.