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Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke.

Publication ,  Journal Article
Barsic, B; Dickerman, S; Krajinovic, V; Pappas, P; Altclas, J; Carosi, G; Casabé, JH; Chu, VH; Delahaye, F; Edathodu, J; Fortes, CQ; Patel, M ...
Published in: Clin Infect Dis
January 2013

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.

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Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

January 2013

Volume

56

Issue

2

Start / End Page

209 / 217

Location

United States

Related Subject Headings

  • Time Factors
  • Stroke
  • Middle Aged
  • Microbiology
  • Male
  • Inpatients
  • Humans
  • Hospital Mortality
  • Female
  • Endocarditis
 

Citation

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Barsic, B., Dickerman, S., Krajinovic, V., Pappas, P., Altclas, J., Carosi, G., … International Collaboration on Endocarditis–Prospective Cohort Study Investigators, . (2013). Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke. Clin Infect Dis, 56(2), 209–217. https://doi.org/10.1093/cid/cis878
Barsic, Bruno, Stuart Dickerman, Vladimir Krajinovic, Paul Pappas, Javier Altclas, Giampiero Carosi, José H. Casabé, et al. “Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke.Clin Infect Dis 56, no. 2 (January 2013): 209–17. https://doi.org/10.1093/cid/cis878.
Barsic B, Dickerman S, Krajinovic V, Pappas P, Altclas J, Carosi G, et al. Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke. Clin Infect Dis. 2013 Jan;56(2):209–17.
Barsic, Bruno, et al. “Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke.Clin Infect Dis, vol. 56, no. 2, Jan. 2013, pp. 209–17. Pubmed, doi:10.1093/cid/cis878.
Barsic B, Dickerman S, Krajinovic V, Pappas P, Altclas J, Carosi G, Casabé JH, Chu VH, Delahaye F, Edathodu J, Fortes CQ, Olaison L, Pangercic A, Patel M, Rudez I, Tamin SS, Vincelj J, Bayer AS, Wang A, International Collaboration on Endocarditis–Prospective Cohort Study Investigators. Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke. Clin Infect Dis. 2013 Jan;56(2):209–217.
Journal cover image

Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

January 2013

Volume

56

Issue

2

Start / End Page

209 / 217

Location

United States

Related Subject Headings

  • Time Factors
  • Stroke
  • Middle Aged
  • Microbiology
  • Male
  • Inpatients
  • Humans
  • Hospital Mortality
  • Female
  • Endocarditis