TY - JOUR
T1 - Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke
AU - International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators
AU - Barsic, Bruno
AU - Dickerman, Stuart
AU - Krajinovic, Vladimir
AU - Pappas, Paul
AU - Altclas, Javier
AU - Carosi, Giampiero
AU - Casabé, José H.
AU - Chu, Vivian H.
AU - Delahaye, Francois
AU - Edathodu, Jameela
AU - Fortes, Claudio Querido
AU - Olaison, Lars
AU - Pangercic, Ana
AU - Patel, Mukesh
AU - Rudez, Igor
AU - Tamin, Syahidah Syed
AU - Vincelj, Josip
AU - Bayer, Arnold S.
AU - Wang, Andrew
AU - Clara, Liliana
AU - Sanchez, Marisa
AU - Nacinovich, Francisco
AU - Oses, Pablo Fernandez
AU - Ronderos, Ricardo
AU - Sucari, Adriana
AU - Thierer, Jorge
AU - Casabé, José
AU - Cortes, Claudia
AU - Kogan, Silvia
AU - Spelman, Denis
AU - Athan, Eugene
AU - Harris, Owen
AU - Kennedy, Karina
AU - Tan, Ren
AU - Gordon, David
AU - Papanicolas, Lito
AU - Eisen, Damon
AU - Grigg, Leeanne
AU - Street, Alan
AU - Korman, Tony
AU - Kotsanas, Despina
AU - Dever, Robyn
AU - Jones, Phillip
AU - Konecny, Pam
AU - Lawrence, Richard
AU - Rees, David
AU - Ryan, Suzanne
AU - Feneley, Michael P.
AU - Harkness, John
AU - Strahilevitz, Jacob
N1 - Funding Information:
Potential conflicts of interest. B. B. is a consultant for Pfizer and Pliva Pharmaceuticals and has also participated as a speaker for MSD, Pfizer, and Pliva. A. S. B. has received grants from Cubist, Astellas, Polymedix Inc, and Trius, and is receiving payments for lectures from Duke University Center (ID Grand Rounds). A. W. has provided expert testimony for Young Moore and Henderson, has received grants from Gilead Sciences, Edward Lifesciences, and Abbott Vascular, and has received honoraria from American Physician, Springer, and the American College of Cardiology Foundation. All other authors report no potential conflicts.
Publisher Copyright:
© The Author 2012.
PY - 2013/1/15
Y1 - 2013/1/15
N2 - Background. The timing of cardiac surgery after stroke in infective endocarditis (IE) remains controversial. We examined the relationship between the timing of surgery after stroke and the incidence of in-hospital and 1-year mortalities. Methods. Data were obtained from the International Collaboration on Endocarditis-Prospective Cohort Study of 4794 patients with definite IE who were admitted to 64 centers from June 2000 through December 2006. Multivariate logistic regression and Cox regression analyses were performed to estimate the impact of early surgery on hospital and 1-year mortality after adjustments for other significant covariates. Results. Of the 857 patients with IE complicated by ischemic stroke syndromes, 198 who underwent valve replacement surgery poststroke were available for analysis. Overall, 58 (29.3%) patients underwent early surgical treatment vs 140 (70.7%) patients who underwent late surgical treatment. After adjustment for other risk factors, early surgery was not significantly associated with increased in-hospital mortality rates (odds ratio, 2.308; 95% confidence interval[CI], .942-5.652). Overall, probability of death after 1-year follow-up did not differ between 2 treatment groups (27.1% in early surgery and 19.2% in late surgery group, P = .328; adjusted hazard ratio, 1.138; 95% CI, .802-1.650). Conclusions. There is no apparent survival benefit in delaying surgery when indicated in IE patients after ischemic stroke. Further observational analyses that include detailed pre- and postoperative clinical neurologic findings and advanced imaging data (eg, ischemic stroke size), may allow for more refined recommendations on the optimal timing of valvular surgery in patients with IE and recent stroke syndromes.
AB - Background. The timing of cardiac surgery after stroke in infective endocarditis (IE) remains controversial. We examined the relationship between the timing of surgery after stroke and the incidence of in-hospital and 1-year mortalities. Methods. Data were obtained from the International Collaboration on Endocarditis-Prospective Cohort Study of 4794 patients with definite IE who were admitted to 64 centers from June 2000 through December 2006. Multivariate logistic regression and Cox regression analyses were performed to estimate the impact of early surgery on hospital and 1-year mortality after adjustments for other significant covariates. Results. Of the 857 patients with IE complicated by ischemic stroke syndromes, 198 who underwent valve replacement surgery poststroke were available for analysis. Overall, 58 (29.3%) patients underwent early surgical treatment vs 140 (70.7%) patients who underwent late surgical treatment. After adjustment for other risk factors, early surgery was not significantly associated with increased in-hospital mortality rates (odds ratio, 2.308; 95% confidence interval[CI], .942-5.652). Overall, probability of death after 1-year follow-up did not differ between 2 treatment groups (27.1% in early surgery and 19.2% in late surgery group, P = .328; adjusted hazard ratio, 1.138; 95% CI, .802-1.650). Conclusions. There is no apparent survival benefit in delaying surgery when indicated in IE patients after ischemic stroke. Further observational analyses that include detailed pre- and postoperative clinical neurologic findings and advanced imaging data (eg, ischemic stroke size), may allow for more refined recommendations on the optimal timing of valvular surgery in patients with IE and recent stroke syndromes.
KW - endocarditis
KW - stroke
KW - surgery
UR - http://www.scopus.com/inward/record.url?scp=84871784303&partnerID=8YFLogxK
U2 - 10.1093/cid/cis878
DO - 10.1093/cid/cis878
M3 - Article
C2 - 23074311
AN - SCOPUS:84871784303
SN - 1058-4838
VL - 56
SP - 209
EP - 217
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 2
ER -
