Prognostic impact of cardiac surgery in left-sided infective endocarditis according to risk profile
ObjectiveTo evaluate the prognostic impact of urgent cardiac surgery on the prognosis of left-sided infective endocarditis (LSIE) and its relationship to the basal risk of the patient and to the surgical indication.Methods605 patients with LSIE and formal surgical indication were consecutively recru...
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| Veröffentlicht in: | Heart (British Cardiac Society) 2021-12, Vol.107 (24), p.1987-1994 |
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| container_end_page | 1994 |
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| container_issue | 24 |
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| container_title | Heart (British Cardiac Society) |
| container_volume | 107 |
| creator | Garcia Granja, Pablo Elpidio Lopez, Javier Vilacosta, Isidre Saéz, Carmen Cabezón, Gonzalo Olmos, Carmen Jerónimo, Adrián Pérez, Javier B De Stefano, Salvatore Maroto, Luis Carnero, Manuel Monguio, Emilio Pulido, Paloma de Miguel, María Gomez Salvador, Itziar Carrasco-Moraleja, Manuel San Román, J Alberto |
| description | ObjectiveTo evaluate the prognostic impact of urgent cardiac surgery on the prognosis of left-sided infective endocarditis (LSIE) and its relationship to the basal risk of the patient and to the surgical indication.Methods605 patients with LSIE and formal surgical indication were consecutively recruited between 2000 and 2020 among three tertiary centres: 405 underwent surgery during the active phase of the disease and 200 did not despite having indication. The prognostic impact of urgent surgery was evaluated by multivariable analysis and propensity score analysis. We studied the benefit of surgery according to baseline mortality risk defined by the ENDOVAL score and according to surgical indication.ResultsSurgery is an independent predictor of survival in LSIE with surgical indication both by multivariable analysis (OR 0.260, 95% CI 0.162 to 0.416) and propensity score (mortality 40% vs 66%, p |
| doi_str_mv | 10.1136/heartjnl-2021-319661 |
| format | Article |
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The prognostic impact of urgent surgery was evaluated by multivariable analysis and propensity score analysis. We studied the benefit of surgery according to baseline mortality risk defined by the ENDOVAL score and according to surgical indication.ResultsSurgery is an independent predictor of survival in LSIE with surgical indication both by multivariable analysis (OR 0.260, 95% CI 0.162 to 0.416) and propensity score (mortality 40% vs 66%, p<0.001). Its greatest prognostic benefit is seen in patients at highest risk (predicted mortality 80%–100%: OR 0.08, 95% CI 0.021 to 0.299). The benefit of surgery is especially remarkable for uncontrolled infection indication (OR 0.385, 95% CI 0.194 to 0.765), even in combination with heart failure (OR 0.220, 95% CI 0.077 to 0.632).ConclusionsSurgery during active LSIE seems to significantly reduce in-hospital mortality. The higher the risk, the higher the improvement in outcome.</description><identifier>ISSN: 1355-6037</identifier><identifier>EISSN: 1468-201X</identifier><identifier>DOI: 10.1136/heartjnl-2021-319661</identifier><identifier>PMID: 34509995</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd and British Cardiovascular Society</publisher><subject>Age ; Aged ; Antibiotics ; cardiac surgery ; Cardiac Surgical Procedures - methods ; Cardiac Surgical Procedures - mortality ; Embolisms ; Endocarditis ; Endocarditis, Bacterial - complications ; Endocarditis, Bacterial - diagnosis ; Endocarditis, Bacterial - mortality ; ENDOVAL score ; Female ; Follow-Up Studies ; Fungi ; Heart Diseases - complications ; Heart Diseases - mortality ; Heart Diseases - surgery ; Heart failure ; Heart surgery ; Hospital Mortality - trends ; Hospitals ; Humans ; infective endocarditis ; Male ; Maximum likelihood method ; Medical prognosis ; Microorganisms ; Middle Aged ; mortality ; Patients ; Population ; Prognosis ; Propensity Score ; Prostheses ; Retrospective Studies ; Risk Assessment - methods ; Risk Factors ; risk score ; Sepsis ; Spain - epidemiology ; Staphylococcus infections ; Survival Rate - trends ; Teams ; Valvular heart disease ; Variables</subject><ispartof>Heart (British Cardiac Society), 2021-12, Vol.107 (24), p.1987-1994</ispartof><rights>Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2021 Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b416t-112a24981bd5a4e2394b8407a165338483cdc3dceba9c9d0ab05d928761b15af3</citedby><cites>FETCH-LOGICAL-b416t-112a24981bd5a4e2394b8407a165338483cdc3dceba9c9d0ab05d928761b15af3</cites><orcidid>0000-0002-0750-1567 ; 0000-0003-0764-0839</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,27907,27908</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34509995$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Garcia Granja, Pablo Elpidio</creatorcontrib><creatorcontrib>Lopez, Javier</creatorcontrib><creatorcontrib>Vilacosta, Isidre</creatorcontrib><creatorcontrib>Saéz, Carmen</creatorcontrib><creatorcontrib>Cabezón, Gonzalo</creatorcontrib><creatorcontrib>Olmos, Carmen</creatorcontrib><creatorcontrib>Jerónimo, Adrián</creatorcontrib><creatorcontrib>Pérez, Javier B</creatorcontrib><creatorcontrib>De Stefano, Salvatore</creatorcontrib><creatorcontrib>Maroto, Luis</creatorcontrib><creatorcontrib>Carnero, Manuel</creatorcontrib><creatorcontrib>Monguio, Emilio</creatorcontrib><creatorcontrib>Pulido, Paloma</creatorcontrib><creatorcontrib>de Miguel, María</creatorcontrib><creatorcontrib>Gomez Salvador, Itziar</creatorcontrib><creatorcontrib>Carrasco-Moraleja, Manuel</creatorcontrib><creatorcontrib>San Román, J Alberto</creatorcontrib><title>Prognostic impact of cardiac surgery in left-sided infective endocarditis according to risk profile</title><title>Heart (British Cardiac Society)</title><addtitle>Heart</addtitle><addtitle>Heart</addtitle><description>ObjectiveTo evaluate the prognostic impact of urgent cardiac surgery on the prognosis of left-sided infective endocarditis (LSIE) and its relationship to the basal risk of the patient and to the surgical indication.Methods605 patients with LSIE and formal surgical indication were consecutively recruited between 2000 and 2020 among three tertiary centres: 405 underwent surgery during the active phase of the disease and 200 did not despite having indication. The prognostic impact of urgent surgery was evaluated by multivariable analysis and propensity score analysis. We studied the benefit of surgery according to baseline mortality risk defined by the ENDOVAL score and according to surgical indication.ResultsSurgery is an independent predictor of survival in LSIE with surgical indication both by multivariable analysis (OR 0.260, 95% CI 0.162 to 0.416) and propensity score (mortality 40% vs 66%, p<0.001). Its greatest prognostic benefit is seen in patients at highest risk (predicted mortality 80%–100%: OR 0.08, 95% CI 0.021 to 0.299). The benefit of surgery is especially remarkable for uncontrolled infection indication (OR 0.385, 95% CI 0.194 to 0.765), even in combination with heart failure (OR 0.220, 95% CI 0.077 to 0.632).ConclusionsSurgery during active LSIE seems to significantly reduce in-hospital mortality. The higher the risk, the higher the improvement in outcome.</description><subject>Age</subject><subject>Aged</subject><subject>Antibiotics</subject><subject>cardiac surgery</subject><subject>Cardiac Surgical Procedures - methods</subject><subject>Cardiac Surgical Procedures - mortality</subject><subject>Embolisms</subject><subject>Endocarditis</subject><subject>Endocarditis, Bacterial - complications</subject><subject>Endocarditis, Bacterial - diagnosis</subject><subject>Endocarditis, Bacterial - mortality</subject><subject>ENDOVAL score</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Fungi</subject><subject>Heart Diseases - complications</subject><subject>Heart Diseases - mortality</subject><subject>Heart Diseases - surgery</subject><subject>Heart failure</subject><subject>Heart surgery</subject><subject>Hospital Mortality - trends</subject><subject>Hospitals</subject><subject>Humans</subject><subject>infective endocarditis</subject><subject>Male</subject><subject>Maximum likelihood method</subject><subject>Medical prognosis</subject><subject>Microorganisms</subject><subject>Middle Aged</subject><subject>mortality</subject><subject>Patients</subject><subject>Population</subject><subject>Prognosis</subject><subject>Propensity Score</subject><subject>Prostheses</subject><subject>Retrospective Studies</subject><subject>Risk Assessment - methods</subject><subject>Risk Factors</subject><subject>risk score</subject><subject>Sepsis</subject><subject>Spain - epidemiology</subject><subject>Staphylococcus infections</subject><subject>Survival Rate - trends</subject><subject>Teams</subject><subject>Valvular heart disease</subject><subject>Variables</subject><issn>1355-6037</issn><issn>1468-201X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqNkU1LHTEYhUNR6kf7D4oE3HQzNW--ZrIsYlUQ6kLBXcgkmdtcZya3SUbw3zd61UIXxVXehOecHN6D0Bcg3wCYPPnlTSrreWwoodAwUFLCB7QPXHb1Ce526syEaCRh7R46yHlNCOGqkx_RHuOCKKXEPrLXKa7mmEuwOEwbYwuOA7YmuWAszkta-fSIw4xHP5QmB-ddvQ3elvDgsZ9dfGZLyNhYG-s4r3CJOIV8jzcpDmH0n9DuYMbsP7-ch-j2x9nN6UVz9fP88vT7VdNzkKUBoIbWgNA7YbinTPG-46Q1IAVjHe-YdZY563ujrHLE9EQ4RbtWQg_CDOwQfd361n9_Lz4XPYVs_Tia2cclaypaShm0QCt6_A-6jkuaazpNJaEc6qZkpfiWsinmnPygNylMJj1qIPqpBP1agn4qQW9LqLKjF_Oln7x7E71uvQInW6Cf1u-1JH8Vb1H_K_kDWF2jzw</recordid><startdate>20211201</startdate><enddate>20211201</enddate><creator>Garcia Granja, Pablo Elpidio</creator><creator>Lopez, Javier</creator><creator>Vilacosta, Isidre</creator><creator>Saéz, Carmen</creator><creator>Cabezón, Gonzalo</creator><creator>Olmos, Carmen</creator><creator>Jerónimo, Adrián</creator><creator>Pérez, Javier B</creator><creator>De Stefano, Salvatore</creator><creator>Maroto, Luis</creator><creator>Carnero, Manuel</creator><creator>Monguio, Emilio</creator><creator>Pulido, Paloma</creator><creator>de Miguel, María</creator><creator>Gomez Salvador, Itziar</creator><creator>Carrasco-Moraleja, Manuel</creator><creator>San Román, J Alberto</creator><general>BMJ Publishing Group Ltd and British Cardiovascular Society</general><general>BMJ Publishing Group LTD</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0750-1567</orcidid><orcidid>https://orcid.org/0000-0003-0764-0839</orcidid></search><sort><creationdate>20211201</creationdate><title>Prognostic impact of cardiac surgery in left-sided infective endocarditis according to risk profile</title><author>Garcia Granja, Pablo Elpidio ; Lopez, Javier ; Vilacosta, Isidre ; Saéz, Carmen ; Cabezón, Gonzalo ; Olmos, Carmen ; Jerónimo, Adrián ; Pérez, Javier B ; De Stefano, Salvatore ; Maroto, Luis ; Carnero, Manuel ; Monguio, Emilio ; Pulido, Paloma ; de Miguel, María ; Gomez Salvador, Itziar ; Carrasco-Moraleja, Manuel ; San Román, J Alberto</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b416t-112a24981bd5a4e2394b8407a165338483cdc3dceba9c9d0ab05d928761b15af3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Age</topic><topic>Aged</topic><topic>Antibiotics</topic><topic>cardiac surgery</topic><topic>Cardiac Surgical Procedures - methods</topic><topic>Cardiac Surgical Procedures - mortality</topic><topic>Embolisms</topic><topic>Endocarditis</topic><topic>Endocarditis, Bacterial - complications</topic><topic>Endocarditis, Bacterial - diagnosis</topic><topic>Endocarditis, Bacterial - mortality</topic><topic>ENDOVAL score</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Fungi</topic><topic>Heart Diseases - complications</topic><topic>Heart Diseases - mortality</topic><topic>Heart Diseases - surgery</topic><topic>Heart failure</topic><topic>Heart surgery</topic><topic>Hospital Mortality - trends</topic><topic>Hospitals</topic><topic>Humans</topic><topic>infective endocarditis</topic><topic>Male</topic><topic>Maximum likelihood method</topic><topic>Medical prognosis</topic><topic>Microorganisms</topic><topic>Middle Aged</topic><topic>mortality</topic><topic>Patients</topic><topic>Population</topic><topic>Prognosis</topic><topic>Propensity Score</topic><topic>Prostheses</topic><topic>Retrospective Studies</topic><topic>Risk Assessment - methods</topic><topic>Risk Factors</topic><topic>risk score</topic><topic>Sepsis</topic><topic>Spain - epidemiology</topic><topic>Staphylococcus infections</topic><topic>Survival Rate - trends</topic><topic>Teams</topic><topic>Valvular heart disease</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Garcia Granja, Pablo Elpidio</creatorcontrib><creatorcontrib>Lopez, Javier</creatorcontrib><creatorcontrib>Vilacosta, Isidre</creatorcontrib><creatorcontrib>Saéz, Carmen</creatorcontrib><creatorcontrib>Cabezón, Gonzalo</creatorcontrib><creatorcontrib>Olmos, Carmen</creatorcontrib><creatorcontrib>Jerónimo, Adrián</creatorcontrib><creatorcontrib>Pérez, Javier B</creatorcontrib><creatorcontrib>De Stefano, Salvatore</creatorcontrib><creatorcontrib>Maroto, Luis</creatorcontrib><creatorcontrib>Carnero, Manuel</creatorcontrib><creatorcontrib>Monguio, Emilio</creatorcontrib><creatorcontrib>Pulido, Paloma</creatorcontrib><creatorcontrib>de Miguel, María</creatorcontrib><creatorcontrib>Gomez Salvador, Itziar</creatorcontrib><creatorcontrib>Carrasco-Moraleja, Manuel</creatorcontrib><creatorcontrib>San Román, J Alberto</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Heart (British Cardiac Society)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Garcia Granja, Pablo Elpidio</au><au>Lopez, Javier</au><au>Vilacosta, Isidre</au><au>Saéz, Carmen</au><au>Cabezón, Gonzalo</au><au>Olmos, Carmen</au><au>Jerónimo, Adrián</au><au>Pérez, Javier B</au><au>De Stefano, Salvatore</au><au>Maroto, Luis</au><au>Carnero, Manuel</au><au>Monguio, Emilio</au><au>Pulido, Paloma</au><au>de Miguel, María</au><au>Gomez Salvador, Itziar</au><au>Carrasco-Moraleja, Manuel</au><au>San Román, J Alberto</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic impact of cardiac surgery in left-sided infective endocarditis according to risk profile</atitle><jtitle>Heart (British Cardiac Society)</jtitle><stitle>Heart</stitle><addtitle>Heart</addtitle><date>2021-12-01</date><risdate>2021</risdate><volume>107</volume><issue>24</issue><spage>1987</spage><epage>1994</epage><pages>1987-1994</pages><issn>1355-6037</issn><eissn>1468-201X</eissn><abstract>ObjectiveTo evaluate the prognostic impact of urgent cardiac surgery on the prognosis of left-sided infective endocarditis (LSIE) and its relationship to the basal risk of the patient and to the surgical indication.Methods605 patients with LSIE and formal surgical indication were consecutively recruited between 2000 and 2020 among three tertiary centres: 405 underwent surgery during the active phase of the disease and 200 did not despite having indication. The prognostic impact of urgent surgery was evaluated by multivariable analysis and propensity score analysis. We studied the benefit of surgery according to baseline mortality risk defined by the ENDOVAL score and according to surgical indication.ResultsSurgery is an independent predictor of survival in LSIE with surgical indication both by multivariable analysis (OR 0.260, 95% CI 0.162 to 0.416) and propensity score (mortality 40% vs 66%, p<0.001). Its greatest prognostic benefit is seen in patients at highest risk (predicted mortality 80%–100%: OR 0.08, 95% CI 0.021 to 0.299). The benefit of surgery is especially remarkable for uncontrolled infection indication (OR 0.385, 95% CI 0.194 to 0.765), even in combination with heart failure (OR 0.220, 95% CI 0.077 to 0.632).ConclusionsSurgery during active LSIE seems to significantly reduce in-hospital mortality. The higher the risk, the higher the improvement in outcome.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd and British Cardiovascular Society</pub><pmid>34509995</pmid><doi>10.1136/heartjnl-2021-319661</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-0750-1567</orcidid><orcidid>https://orcid.org/0000-0003-0764-0839</orcidid></addata></record> |
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| subjects | Age Aged Antibiotics cardiac surgery Cardiac Surgical Procedures - methods Cardiac Surgical Procedures - mortality Embolisms Endocarditis Endocarditis, Bacterial - complications Endocarditis, Bacterial - diagnosis Endocarditis, Bacterial - mortality ENDOVAL score Female Follow-Up Studies Fungi Heart Diseases - complications Heart Diseases - mortality Heart Diseases - surgery Heart failure Heart surgery Hospital Mortality - trends Hospitals Humans infective endocarditis Male Maximum likelihood method Medical prognosis Microorganisms Middle Aged mortality Patients Population Prognosis Propensity Score Prostheses Retrospective Studies Risk Assessment - methods Risk Factors risk score Sepsis Spain - epidemiology Staphylococcus infections Survival Rate - trends Teams Valvular heart disease Variables |
| title | Prognostic impact of cardiac surgery in left-sided infective endocarditis according to risk profile |
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