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.
Bibliographical noteFunding 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.
© The Author 2012.