Association between the timing of surgery for complicated, left-sided infective endocarditis and survival

被引:30
|
作者
Wang, Andrew [1 ]
Chu, Vivian H. [1 ]
Athan, Eugene [2 ,3 ]
Delahaye, Francois [4 ]
Freiberger, Tomas [5 ]
Lamas, Cristiane [6 ,7 ]
Miro, Jose M. [8 ]
Strahilevitz, Jacob [9 ]
Tribouilloy, Christophe [10 ,11 ]
Durante-Mangoni, Emanuele [12 ]
Pericas, Juan M. [8 ]
Fernandez-Hidalgo, Nuria [13 ]
Nacinovich, Francisco [14 ]
Barsic, Bruno [15 ]
Giannitsioti, Efthymia [16 ]
Hurley, John P. [17 ]
Hannan, Margaret M. [17 ]
Park, Lawrence P. [1 ]
机构
[1] Duke Univ, Med Ctr, Durham, NC USA
[2] Barwon Hlth, Geelong, Vic, Australia
[3] Deakin Univ, Geelong, Vic, Australia
[4] Hosp Louis Pradel, Bron, France
[5] Ctr Cardiovasc Surg & Transplantat, Brno, Czech Republic
[6] Inst Natl Cardiol, Rio De Janeiro, Brazil
[7] Unigranrio, Rio De Janeiro, Brazil
[8] Univ Barcelona, Hosp Clin IDIBAPS, Infect Dis Serv, Barcelona, Spain
[9] Hadassah Hebrew Univ, Med Ctr, Jerusalem, Israel
[10] Univ Hosp, Amiens, France
[11] Univ Picardie, INSERM, U1088, Amiens, France
[12] Univ Campania, Monaldi Hosp, Internal Med, Naples, Italy
[13] Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Serv Malad Infeccioses, Barcelona, Spain
[14] Inst Cardiovasc Buenos Aires, Buenos Aires, DF, Argentina
[15] Univ Zagreb, Sch Med, Hosp Infect Dis, Zagreb, Croatia
[16] Attikon Univ Gen Hosp, Athens, Greece
[17] Mater Misericordiae Univ Hosp, Dublin, Ireland
关键词
NATIVE VALVE ENDOCARDITIS; ANTIMICROBIAL THERAPY; 6-MONTH MORTALITY; CARDIAC-SURGERY; REFERRAL BIAS; IMPACT; MANAGEMENT; ADULTS; RISK; DIAGNOSIS;
D O I
10.1016/j.ahj.2019.01.004
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background In patients with active infective endocarditis (IE), the relationship between timing of surgery and survival is uncertain. The objective was to evaluate clinical characteristics associated with timing of surgery and the association between surgical timing and 6-month survival in complicated, left-sided IE. Methods In a prospective, multicenter, observational registry (The International Collaboration on Endocarditis-PLUS, registry from 2008 to 2012), clinical factors associated with timing of surgery during the index hospitalization were determined among 485 adult patients with definite, complicated, left-sided IE who underwent cardiac surgery during their index hospitalization. The relationship between early surgical intervention (<7 days from admission to surgery center) and outcome after surgery was analyzed. The primary end point of the study was 6-month survival. Results The median time to surgery from admission to surgical center was 7 (interquartile range 2-15) days. Patients who underwent earlier surgery were more likely transferred to the surgical center (74.2% vs 46.4%, P < .001) and had a lower percentage of preexisting heart failure (before IE diagnosis) (6.0% vs 17.3%, P < .001) but higher rate of acute heart failure (53.2% vs 38.4%, P = .001). Variables independently associated with surgery <7 days from admission were patient transfer, acute heart failure, and nonelective surgical status (C-index = 0.84), but predicted operative risk was not. Cox proportional hazards modeling with inverse probability of treatment weighting found that earlier surgery was associated with a trend toward higher 6-month mortality compared with later surgery (hazard ratio = 1.68, 95% CI 0.97-2.96; P = .065), particularly surgery with in 2 days of admission or transfer. Mortality was significantly associated with operative risk and complicated IE, including Staphylococcus aureus infection and presence of abscess. Conclusions Earlier surgery in IE is strongly associated with acute heart failure and surgical urgency. After adjustment for operative risk and IE complications, earlier surgery <7 days from admission was associated with a trend toward higher 6-month overall mortality compared with surgery later in the index hospitalization.
引用
收藏
页码:108 / 116
页数:9
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