Surgical Outcomes of Infective Endocarditis among Intravenous Drug Users

Abstracts Background With increasing prevalence of injection drug use in the United States, a growing number of intravenous drug users (IVDU) are at risk for infective endocarditis (IE) that may require surgical intervention, however, little data exist about clinical outcomes of these individuals. Methods We evaluated consecutive adult patients undergoing surgery for active IE between 2002 and 2014 pooled from two prospective institutional databases. Death and valve-related events including reinfection or heart valve reoperation, thromboembolism, and anticoagulation-related hemorrhage were evaluated. Results Of the 436 patients identified, 78 (17.9%) were current IVDU. The proportion of IVDU increased from 14.8% in 2002-2004 to 26.1% in 2012-2014. IVDU were younger (35.9±9.9 vs. 59.3±14.1yrs) and had fewer cardiovascular risk factors than non- IVDU. During follow-up (median, 29.4 mo; Quartile 1-3, 4.7-72.6 mo), adverse events among all patients included death in 92, reinfection in 42, valve-reoperation in 35, thromboembolism in 17 and hemorrhage in 16. Operative mortality was lower among IVDU (OR, 0.25; 95% CI, 0.06-0.71), but overall mortality was not significantly different (HR, 0.78; 95% CI, 0.44-1.37). When baseline profiles were adjusted by propensity score, IVDU had higher risk of valve-related complications (HR, 3.82; 95% CI, 1.95-7.49), P