Long-Term Clinical Outcome of Major Adverse Cardiac Events in Survivors of Infectious Endocarditis: A Nationwide Population-Based Study
Background—Substantial infective endocarditis (IE)-related morbidity and mortality may occur even after successful treatment. However, no previous study has explored long-term hard endpoints (i.e., stroke, myocardial infarction, heart failure, cardiovascular death) in addition to all-cause mortality in IE survivors.
Methods and Results—A nationwide population-based cohort study was conducted among IE survivors identified using Taiwan's National Health Insurance Research Database during 2000-2009. IE survivors were defined as those who survived after discharge from first hospitalization with a diagnosis of IE. A total of 10,116 IE survivors were identified. IE survivors were matched to control subjects without IE at a 1:1 ratio using propensity scores. The primary outcomes were stroke, myocardial infarction, readmission for heart failure, and sudden cardiac death or ventricular arrhythmia. The secondary outcomes were repeat IE and all-cause mortality. Compared with the matched cohort, IE survivors had higher risks of ischemic stroke (adjusted hazard ratio [aHR], 1.59; 95% confidence interval [CI], 1.40 to 1.80), hemorrhagic stroke (aHR, 2.37; 95% CI, 1.90 to 2.96), myocardial infarction (aHR, 1.44; 95% CI, 1.17 to 1.79), readmission for heart failure (aHR, 2.24; 95% CI, 2.05 to 2.43), sudden death or ventricular arrhythmia (aHR, 1.69; 95% CI, 1.44 to 1.98) and all-cause death (aHR, 2.27; 95% CI, 2.14 to 2.40). Risk factors for repeat IE were older age, male sex, drug abuser, and valvular replacement after an initial episode of IE.
Conclusions—Despite treatment, the risk of long-term major adverse cardiac events was substantially increased in IE survivors.
- Received August 9, 2014.
- Revision received August 30, 2014.
- Accepted September 4, 2014.