Association between valvular surgery and mortality among patients with infective endocarditis complicated by heart failure.

Details

Serval ID
serval:BIB_700CDA8157D9
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Association between valvular surgery and mortality among patients with infective endocarditis complicated by heart failure.
Journal
JAMA
Author(s)
Kiefer T., Park L., Tribouilloy C., Cortes C., Casillo R., Chu V., Delahaye F., Durante-Mangoni E., Edathodu J., Falces C., Logar M., Miró J.M., Naber C., Tripodi M.F., Murdoch D.R., Moreillon P., Utili R., Wang A.
ISSN
1538-3598 (Electronic)
ISSN-L
0098-7484
Publication state
Published
Issued date
2011
Volume
306
Number
20
Pages
2239-2247
Language
english
Abstract
Context Heart failure (HF) is the most common complication of infective endocarditis. However, clinical characteristics of HF in patients with infective endocarditis, use of surgical therapy, and their associations with patient outcome are not well described.Objectives To determine the clinical, echocardiographic, and microbiological variables associated with HF in patients with definite infective endocarditis and to examine variables independently associated with in-hospital and 1-year mortality for patients with infective endocarditis and HF, including the use and association of surgery with outcome.Design, Setting, and Patients The International Collaboration on Endocarditis-Prospective Cohort Study, a prospective, multicenter study enrolling 4166 patients with definite native- or prosthetic-valve infective endocarditis from 61 centers in 28 countries between June 2000 and December 2006.Main Outcome Measures In-hospital and 1-year mortality.Results Of 4075 patients with infective endocarditis and known HF status enrolled, 1359 (33.4% [95% CI, 31.9%-34.8%]) had HF, and 906 (66.7% [95% CI, 64.2%-69.2%]) were classified as having New York Heart Association class III or IV symptom status. Within the subset with HF, 839 (61.7% [95% CI, 59.2%-64.3%]) underwent valvular surgery during the index hospitalization. In-hospital mortality was 29.7% (95% CI, 27.2%-32.1%) for the entire HF cohort, with lower mortality observed in patients undergoing valvular surgery compared with medical therapy alone (20.6% [95% CI, 17.9%-23.4%] vs 44.8% [95% CI, 40.4%-49.0%], respectively; P < .001). One-year mortality was 29.1% (95% CI, 26.0%-32.2%) in patients undergoing valvular surgery vs 58.4% (95% CI, 54.1%-62.6%) in those not undergoing surgery (P < .001). Cox proportional hazards modeling with propensity score adjustment for surgery showed that advanced age, diabetes mellitus, health care-associated infection, causative microorganism (Staphylococcus aureus or fungi), severe HF (New York Heart Association class III or IV), stroke, and paravalvular complications were independently associated with 1-year mortality, whereas valvular surgery during the initial hospitalization was associated with lower mortality.Conclusion In this cohort of patients with infective endocarditis complicated by HF, severity of HF was strongly associated with surgical therapy and subsequent mortality, whereas valvular surgery was associated with lower in-hospital and 1-year mortality.
Keywords
Aged, Cardiovascular Surgical Procedures/mortality, Cohort Studies, Echocardiography, Endocarditis/complications, Endocarditis/microbiology, Female, Heart Failure/etiology, Heart Failure/mortality, Heart Valves/surgery, Hospital Mortality, Humans, Male, Middle Aged, Mortality/trends, Prospective Studies
Pubmed
Web of science
Open Access
Yes
Create date
08/12/2011 10:06
Last modification date
20/08/2019 14:28
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