Abstract W P152: Twenty Years Later: The Changing Picture of Infective Endocarditis in a Large Urban Center

Abstract

Purpose: St. Paul’s Hospital serves a low-SES, high-risk population in Vancouver’s ‘Downtown East Side.’ Our study characterizes the changing epidemiology, neurologic complications, investigation methods and outcomes of this group from 1995 to 2014. To date, our database is among the world’s largest. Methods: This retrospective chart review used ICD-9 codes to identify 922 cases of infective endocarditis satisfying Duke Criteria. We collected demographic data including Intravenous drug use (IVDU), HIV and Hepatitis status, and clinical data including neurologic complications, mortality rates and treatment. The cohort was divided into IVDU and non-IVDU and ‘first decade’ (1995-2005) versus ‘second decade’ (2006-2014). Univariate analysis was performed using chi-square and non-parametric t-tests. Results: Mortality was not different between the first and second decades [105/669 (15.7%) vs 35/253 (13.8%) p=0.4] but was significantly greater in non-IVDUs than IVDUs in the first decade only [61/297 (20.5%) vs 44/369 (11.9%) p=0.002]. Neurologic complications [141/922 (15.3%)] were more frequent in non-IVDUs versus IVDUs in the first decade only [44/310 (14.2%) vs 33/359 (9.2%) p=0.04]. Neurologic complications were more frequent in the second versus first decade [64/253 (25.3%) vs 77/669 (11.5%) p<0.001]. Mycotic aneurysms (MA) were more frequent in the second decade [11/253 (4.3%) vs 4/665 (0.6%) p<0.001]. In patients investigated for MA, CTA was employed more frequently in the second decade [31/64 (48%) vs 5/77 (6.5%) p<0.001]. Subjects with neurologic complications were more likely to receive cardiac surgery than those without neurologic complications in the first decade (OR=2.4, 95% CI:1.9-2.9) only. Conclusions: Our data show a trend toward a reduction in overall mortality from IE, but an increase in neurologic complications, particularly in non-IVDU patients. Embolic stroke remains the most frequent neurologic complication. Mycotic aneurysms remain uncommon. We observed a shift in favor of CTA vs DSA for the detection of MAs, with a corresponding increase in the frequency of MAs. The appropriateness of this practice remains to be determined.