Association Between Surgical Indications, Operative Risk, and Clinical Outcome in Infective Endocarditis

Chu, Vivian H.; Park, Lawrence P.; Athan, Eugene; Delahaye, François; Freiberger, Tomáš; Lamas, Cristiane da Cruz; Miró, José M.; Mudrick, Daniel W.; Strahilevitz, Jacob; Tribouilloy, Christophe; Durante‐Mangoni, Emanuele; Pericàs, Juan M.; Fernández-Hidalgo, Núria; Nacinovich, Francisco; Rizk, H.; Krajinović, Vladimir; Giannitsioti, Efthymia; Hurley, John P.; Hannan, Margaret M.; Wang, Andrew

doi:10.1161/circulationaha.114.012461

Cited by 232 publications

(108 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our recent study of surgical indications and treatment in the ICE‐PLUS cohort found that approximately one‐quarter of left‐sided IE cases with indications for surgery did not undergo surgery due to operative risk factors, such as sepsis, but that surgery was associated with a survival benefit after adjustment for operative risk 12. The present study highlights the risk of death related to host and IE characteristics even beyond the period of surgical intervention.…”

Section: Discussionmentioning

confidence: 61%

“…Regional differences in IE characteristics and treatment may exist within the cohort, but sensitivity analysis by geographic region did not substantially change the hazard ratios for mortality in the derivation model. The use of surgery was not prespecified by a study protocol, but we have previously found that surgery was performed for guideline‐directed indications6, 7 in the ICE‐PLUS cohort 12. Although treatment selection bias for surgery may influence the results of the present study, surgical intervention was evaluated as a time‐dependent variable with inverse probability adjustment for surgery in both models.…”

Section: Discussionmentioning

confidence: 99%

“…The model included variables that were selected a priori by an experienced cardiologist (A.W.) and from practice guidelines6, 7 and previous studies1, 12, 13 because those would be evaluated in the decision to treat IE with surgery. These variables were age >70 years, history of hemodialysis, history of intravenous drug use, time of ≥1 month since first IE manifestation, paravalvular complication, New York Heart Association class 3 or 4 (versus 1 or 2), aortic valve vegetation, new mitral or aortic valve regurgitation, and causative microorganism ( S aureus , coagulase‐negative staphylococci, and viridans group streptococci).…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Validated Risk Score for Predicting 6‐Month Mortality in Infective Endocarditis

Park

Peterson

Skoutelis

et al. 2016

JAHA

Self Cite

108

View full text Add to dashboard Cite

BackgroundHost factors and complications have been associated with higher mortality in infective endocarditis (IE). We sought to develop and validate a model of clinical characteristics to predict 6‐month mortality in IE.Methods and ResultsUsing a large multinational prospective registry of definite IE (International Collaboration on Endocarditis [ICE]–Prospective Cohort Study [PCS], 2000–2006, n=4049), a model to predict 6‐month survival was developed by Cox proportional hazards modeling with inverse probability weighting for surgery treatment and was internally validated by the bootstrapping method. This model was externally validated in an independent prospective registry (ICE‐PLUS, 2008–2012, n=1197). The 6‐month mortality was 971 of 4049 (24.0%) in the ICE‐PCS cohort and 342 of 1197 (28.6%) in the ICE‐PLUS cohort. Surgery during the index hospitalization was performed in 48.1% and 54.0% of the cohorts, respectively. In the derivation model, variables related to host factors (age, dialysis), IE characteristics (prosthetic or nosocomial IE, causative organism, left‐sided valve vegetation), and IE complications (severe heart failure, stroke, paravalvular complication, and persistent bacteremia) were independently associated with 6‐month mortality, and surgery was associated with a lower risk of mortality (Harrell's C statistic 0.715). In the validation model, these variables had similar hazard ratios (Harrell's C statistic 0.682), with a similar, independent benefit of surgery (hazard ratio 0.74, 95% CI 0.62–0.89). A simplified risk model was developed by weight adjustment of these variables.ConclusionsSix‐month mortality after IE is ≈25% and is predicted by host factors, IE characteristics, and IE complications. Surgery during the index hospitalization is associated with lower mortality but is performed less frequently in the highest risk patients. A simplified risk model may be used to identify specific risk subgroups in IE.

show abstract

Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Validated Risk Score for Predicting 6‐Month Mortality in Infective Endocarditis

Park

Peterson

Skoutelis

et al. 2016

JAHA

Self Cite

108

View full text Add to dashboard Cite

show abstract

“…39,47 In HICs, approximately half of IE patients in reported prospective series' undergo surgical intervention, 1,2,62 with up to 75% of patients with indications for surgery receiving it. 62 In our reviewed studies, although UMIC studies reported surgical intervention rates close to HICs, two lower middle-income country studies reported low rates of 0% and 15%. 19,20 We however found no information on the rates of surgical intervention among patients with indications for surgery, however, given the high rate of complications among IE patients in our reviewed studies, we can conclude that this rate was low.…”

Section: Dismal Access To Surgerymentioning

confidence: 81%

Infective Endocarditis in Low- and Middle-Income Countries

et al. 2017

View full text Add to dashboard Cite

Key Points Staphylococcus is an increasingly important cause of IE in LMICs, and is the leading cause of IE in UMICs  RHD remains the major underlying cardiac pathology of IE in LMICs, identified in almost half of reported cases  The rate of microorganism non-identification is high, reaching up to 60% of IE cases in LMICs, and hampering diagnosis and treatment  Rates of access to surgery in UMICs for complicated IE are as high as in HICs, but remain dismal in lower-middle income countries SynopsisInfective endocarditis (IE) is a rare, life-threatening disease with a mortality rate of upto 25% and significant debilitating morbidities. Although much has been reported on contemporary IE in high income countries, conclusions on the state of IE in low and middle income countries (LMICs) are based on studies conducted before the year 2000. Furthermore, unique challenges in the diagnosis and management of IE persist in LMICs. This article is a review of IE studies conducted in LMICs documenting clinical experiences from the year 2000 to present. We present the causes of IE, management of patients with IE and the prevailing challenges in diagnosis and treatment of IE in LMICs.

show abstract

“…Esto, con base en el reconocimiento de las características de alto riesgo que impiden que el tratamiento antibiótico per se resuelva por completo la infección; entre tales características están: la insuficiencia cardíaca progresiva, la infección no controlada y fenómenos embólicos a repetición, a pesar del tratamiento antibiótico apropiado. El tratamiento quirúrgico es de alta morbilidad, por lo que se debe seleccionar cuidadosamente a los pacientes, con el fin de obtener los mayores beneficios de la intervención, y aunque el tiempo depende de cada situación específica, se sugiere que sea en forma temprana, idealmente en las primeras 48 horas (32). Las indicaciones más frecuentes para plantear el tratamiento quirúrgico fueron: desarrollo de falla cardía-ca, fenómenos embólicos recurrentes a pesar de un tratamiento médico óptimo, bacteriemia persistente, formación de abscesos perivalvulares, el tamaño de la vegetación y el tipo de microorganismo (32,33).…”

Section: Tratamientounclassified

Endocarditis infecciosa

Senior

Gándara-Ricardo

2015

iatreia

View full text Add to dashboard Cite

RESUMENLa endocarditis infecciosa es una enfermedad producida por la colonización y proliferación de agentes infecciosos en la superficie endotelial del corazón. Su presentación clínica es variable pues depende de condiciones propias del hospedero, tales como el estado inmunológico, la presencia de material protésico y el uso de drogas endovenosas, y del agente causal. El diagnóstico se establece, usualmente, mediante la suma de elementos como la historia clínica, el examen físico, los hemocultivos, el ecocardiograma y otras ayudas. Presentamos el caso de un hombre adulto que acudió al hospital con un cuadro clínico de fiebre e insuficiencia cardíaca aguda. Se documentó la presencia de soplo sistólico en el foco aórtico y el ecocardiograma reveló insuficiencia valvular grave y una lesión vegetante sobre la válvula aórtica bicúspide. Requirió reemplazo valvular y completó el tratamiento antibiótico, dirigido por la sensibilidad demostrada, luego de hemocultivos positivos para Streptococcus mitis. PALABRAS CLAVEBacteriemia; Endocarditis; Insuficiencia cardíaca congestiva SUMMARY Infective endocarditisInfective endocarditis is a disease caused by colonization and proliferation of infectious agents on the endothelial surface of the heart. Its clinical presentation is variable, depending upon conditions of the patient, such as immunosuppression, presence of prosthetic material, intravenous drug use, and the etiologic agent. Diagnosis is usually established through the addition of elements such as medical history, physical examination, results of blood cultures, echocardiography and other aids. We present the case of an adult male who came to the hospital with fever and symptoms and signs of acute heart failure. The presence of a systolic murmur was documented in the aortic area, and the echocardiogram revealed severe valve regurgitation and a vegetating lesion on the bicuspid aortic valve. He required valve replacement and

show abstract

Association Between Surgical Indications, Operative Risk, and Clinical Outcome in Infective Endocarditis

Cited by 232 publications

References 40 publications

Validated Risk Score for Predicting 6‐Month Mortality in Infective Endocarditis

Validated Risk Score for Predicting 6‐Month Mortality in Infective Endocarditis

Infective Endocarditis in Low- and Middle-Income Countries

Endocarditis infecciosa

Contact Info

Product

Resources

About