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

International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)209-217
Number of pages9
JournalClinical Infectious Diseases
Volume56
Issue number2
DOIs
StatePublished - Jan 15 2013

Fingerprint

Endocarditis
Thoracic Surgery
Stroke
Mortality
Confidence Intervals
Neurologic Manifestations
Hospital Mortality
Cohort Studies
Therapeutics
Logistic Models
Odds Ratio
Regression Analysis
Prospective Studies
Survival
Incidence

Keywords

  • endocarditis
  • stroke
  • surgery

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators (2013). Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke. Clinical Infectious Diseases, 56(2), 209-217. https://doi.org/10.1093/cid/cis878

Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke. / International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators.

In: Clinical Infectious Diseases, Vol. 56, No. 2, 15.01.2013, p. 209-217.

Research output: Contribution to journalArticle

International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators 2013, 'Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke', Clinical Infectious Diseases, vol. 56, no. 2, pp. 209-217. https://doi.org/10.1093/cid/cis878
International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators. Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke. Clinical Infectious Diseases. 2013 Jan 15;56(2):209-217. https://doi.org/10.1093/cid/cis878
International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators. / Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke. In: Clinical Infectious Diseases. 2013 ; Vol. 56, No. 2. pp. 209-217.
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abstract = "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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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 - Bedimo, Roger

AU - Peterson, Gail

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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

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