The New Strategy in Infective Endocarditis: Early Surgery Based on Early Diagnosis: Are We Too Late, When Early Surgery is Best?
Patients with infective endocarditis (IE) have a poor prognosis due to complications including congestive heart failure, paravalvular abscess formation, central and peripheral embolism, and hemorrhagic stroke.1 Patients with IE and congestive heart failure (CHF) have a mortality as high as 50%.1 The poor prognosis seems not be improved during recent years.2 In Sweden 7.603 patients with IE received a close follow-up with assessment of the 30-day mortality and 5-year follow-up including autopsy in all fatal events sampled from 1997 to 2007.2 During the observation period no change of mortality was found despite an increase of the incidence of IE from about 7-7.5/100.000 to 8-8.5/100.000 inhabitants.2 In order to provide a contemporary picture of the presentation, etiology, and outcome of infective endocarditis (IE) a worldwide International Collaboration on Endocarditis-Prospective Cohort Study (ICE PCS) was started in 58 hospitals in 25 countries in 2000.3 In this issue of Circulation, Chu VH et al4 report the recent 2008-2012 results of the ICE-PCS database of 1296 IE patients with left sided IE. The hospital mortality for surgery, performed in only 661 (77%) of 863 patients with indications for surgery, reached 14.8% and the 6-month mortality 17.5% compared to 26% and 31.4 %, respectively, when no surgery was provided.4
- ICE-PCS registry
- transesophageal echocardiography
- Received November 11, 2014.
- Revision received November 18, 2014.
- Accepted November 24, 2014.