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https://www.arca.fiocruz.br/handle/icict/37926
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2020-12-13
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- INI - Artigos de Periódicos [3391]
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THE ASSOCIATION BETWEEN VEGETATION SIZE AND SURGICAL TREATMENT ON 6-MONTH MORTALITY IN LEFT-SIDED INFECTIVE ENDOCARDITIS
Author
Fosbøl, Emil L.
Park, Lawrence P.
Chu, Vivian H.
Athan, Eugene
Delahaye, François
Freiberger, Tomas
Lamas, Cristiane
Miro, José M.
Strahilevitz, Jacob
Tribouilloy, Christophe
Durante-Mangoni, Emanuele
Pericas, Juan M.
Fernández-Hidalgo, Nuria
Nacinovich, Francisco
Rizk, Hussein
Barsic, Bruno
Giannitsioti, Efthymia
Hurley, John P.
Hannan, Margaret M.
Wang, Andrew
Park, Lawrence P.
Chu, Vivian H.
Athan, Eugene
Delahaye, François
Freiberger, Tomas
Lamas, Cristiane
Miro, José M.
Strahilevitz, Jacob
Tribouilloy, Christophe
Durante-Mangoni, Emanuele
Pericas, Juan M.
Fernández-Hidalgo, Nuria
Nacinovich, Francisco
Rizk, Hussein
Barsic, Bruno
Giannitsioti, Efthymia
Hurley, John P.
Hannan, Margaret M.
Wang, Andrew
Affilliation
Duke University Medical Center. Durham, NC, USA / University Hospital of Copenhagen. Department of Cardiology. Copenhagen, Denmark / Rigshospitalet. Copenhagen, Denmark.
Duke University Medical Center. Durham, NC, USA.
Duke University Medical Center. Durham, NC, USA.
Barwon Health. Geelong, Australia / Deakin University. Geelong, Australia.
Hospital Louis Pradel. Lyon-Bron, France.
Centre for Cardiovascular Surgery and Transplantation. Brno, Czech Republic / Masaryk University. Central European Institute of Technology. Brno, Czech Republic.
Instituto Nacional de Cardiologia. Rio de Janeiro, RJ, Brasil / Universidade do Grande Rio. Rio de Janeiro, RJ, Brasil.
Hospital Clinic. Infectious Diseases Service. Barcelona, Spain / IDIBAPS. Barcelona, Spain / University of Barcelona. Barcelona, Spain.
Hadassah-Hebrew University Medical Center. Jerusalem, Israel.
University Hospital. Amiens, France / INSERM U-1088. Amiens, France / University of Picardie. Amiens, France.
University of Campania. Internal Medicine. Naples, Italy / Monaldi Hospital. Naples, Italy.
Hospital Clinic. Infectious Diseases Service. Barcelona, Spain / IDIBAPS. Barcelona, Spain / University of Barcelona. Barcelona, Spain.
Hospital Universitari de Barcelona. Servei de MalaltiesInfeccioses. Barcelona, Spain.
Instituto Cardiovascular de Buenos Aires. Buenos Aires, Argentina.
Cairo University Hospital. Cairo, Egypt.
University of Zagreb. School of Medicine University of Zagreb. Zagreb, Croatia. / Hospital for Infectious Diseases. Zagreb, Croatia.
Attikon University. General Hospital. Athens, Greece.
Mater Misericordiae University Hospital. Dublin, Ireland.
Mater Misericordiae University Hospital. Dublin, Ireland.
Duke University Medical Center. Durham, NC, USA / University Hospital of Copenhagen. Department of Cardiology. Copenhagen, Denmark / Rigshospitalet. Copenhagen, Denmark.
Duke University Medical Center. Durham, NC, USA.
Duke University Medical Center. Durham, NC, USA.
Barwon Health. Geelong, Australia / Deakin University. Geelong, Australia.
Hospital Louis Pradel. Lyon-Bron, France.
Centre for Cardiovascular Surgery and Transplantation. Brno, Czech Republic / Masaryk University. Central European Institute of Technology. Brno, Czech Republic.
Instituto Nacional de Cardiologia. Rio de Janeiro, RJ, Brasil / Universidade do Grande Rio. Rio de Janeiro, RJ, Brasil.
Hospital Clinic. Infectious Diseases Service. Barcelona, Spain / IDIBAPS. Barcelona, Spain / University of Barcelona. Barcelona, Spain.
Hadassah-Hebrew University Medical Center. Jerusalem, Israel.
University Hospital. Amiens, France / INSERM U-1088. Amiens, France / University of Picardie. Amiens, France.
University of Campania. Internal Medicine. Naples, Italy / Monaldi Hospital. Naples, Italy.
Hospital Clinic. Infectious Diseases Service. Barcelona, Spain / IDIBAPS. Barcelona, Spain / University of Barcelona. Barcelona, Spain.
Hospital Universitari de Barcelona. Servei de MalaltiesInfeccioses. Barcelona, Spain.
Instituto Cardiovascular de Buenos Aires. Buenos Aires, Argentina.
Cairo University Hospital. Cairo, Egypt.
University of Zagreb. School of Medicine University of Zagreb. Zagreb, Croatia. / Hospital for Infectious Diseases. Zagreb, Croatia.
Attikon University. General Hospital. Athens, Greece.
Mater Misericordiae University Hospital. Dublin, Ireland.
Mater Misericordiae University Hospital. Dublin, Ireland.
Duke University Medical Center. Durham, NC, USA / University Hospital of Copenhagen. Department of Cardiology. Copenhagen, Denmark / Rigshospitalet. Copenhagen, Denmark.
Abstract
In left-sided infective endocarditis (IE), a large vegetation >10 mm is associated with higher mortality, yet it is unknown whether surgery during the acute phase opposed to medical therapy is associated with improved survival. We assessed the association between surgery and 6-month mortality as related to vegetation size.Patients with definite, left-sided IE (2008–2012) from The International Collaboration on Endocarditis prospective, multinational registry were included. We compared clinical characteristics and 6-month mortality (by Cox regression with inverse propensity of treatment weighting) between patients with vegetation size <_10 mm vs. >10 mm in maximum length by surgical treatment strategy. A total of 1006 patients with left sided IE were included; 422 with a vegetation size <_10 mm (median age 66.0 years, 33% women) and 584 (median age 58.4 years, 34% women) patients with a large vegetation >10 mm. Operative risk by STS-IE score was similar between groups. Embolic
events occurred in 28.4% vs. 44.3% (P < 0.001), respectively. Patients with a vegetation >10 mm was associated with higher 6-month mortality (25.1% vs. 19.4% for small vegetation, P = 0.035). However, after propensity adjustment, the association with higher mortality persisted only in patients with a large vegetation >10 mm vs. <_10 mm: hazard ratio (HR) 1.55 (1.27–1.90); but only in patients with large vegetation managed medically [HR 1.86 (1.48–2.34)] rather than surgically [HR 1.01 (0.69–1.49)]. Left-sided IE with vegetation size >10 mm was associated with an increased mortality at 6 months in this observational study but was dependent on treatment strategy. For patients with large vegetation undergoing surgical treatment, survival was similar to patients with smaller vegetation size.
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