In-hospital and 1-year mortality in patients undergoing early surgery for prosthetic valve endocarditis.

Lalani, Tahaniyat, Chu, Vivian H, Park, Lawrence P, Cecchi, Enrico, Corey, G Ralph, Durante-Mangoni, Emanuele, Fowler, Vance G, Gordon, David, Grossi, Paolo, Hannan, Margaret, Hoen, Bruno, Muñoz, Patricia, Rizk, Hussien, Kanj, Souha S, Selton-Suty, Christine, Sexton, Daniel J, Spelman, Denis, Ravasio, Veronica, Tripodi, Marie F, Wang, Andrew, International Collaboration on Endocarditis–Prospective Cohort Study Investigators, and Athan, Eugene 2013, In-hospital and 1-year mortality in patients undergoing early surgery for prosthetic valve endocarditis., JAMA internal medicine, vol. 173, no. 16, pp. 1495-1504, doi: 10.1001/jamainternmed.2013.8203.

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Title In-hospital and 1-year mortality in patients undergoing early surgery for prosthetic valve endocarditis.
Author(s) Lalani, Tahaniyat
Chu, Vivian H
Park, Lawrence P
Cecchi, Enrico
Corey, G Ralph
Durante-Mangoni, Emanuele
Fowler, Vance G
Gordon, David
Grossi, Paolo
Hannan, Margaret
Hoen, Bruno
Muñoz, Patricia
Rizk, Hussien
Kanj, Souha S
Selton-Suty, Christine
Sexton, Daniel J
Spelman, Denis
Ravasio, Veronica
Tripodi, Marie F
Wang, Andrew
International Collaboration on Endocarditis–Prospective Cohort Study Investigators,
Athan, EugeneORCID iD for Athan, Eugene
Journal name JAMA internal medicine
Volume number 173
Issue number 16
Start page 1495
End page 1504
Total pages 10
Publisher American Medical Association
Place of publication Chicago, IL
Publication date 2013-09-09
ISSN 2168-6114
Keyword(s) International Collaboration on Endocarditis–Prospective Cohort Study Investigators
Summary IMPORTANCE: There are limited prospective, controlled data evaluating survival in patients receiving early surgery vs medical therapy for prosthetic valve endocarditis (PVE). OBJECTIVE: To determine the in-hospital and 1-year mortality in patients with PVE who undergo valve replacement during index hospitalization compared with patients who receive medical therapy alone, after controlling for survival and treatment selection bias. DESIGN, SETTING, AND PARTICIPANTS: Participants were enrolled between June 2000 and December 2006 in the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS), a prospective, multinational, observational cohort of patients with infective endocarditis. Patients hospitalized with definite right- or left-sided PVE were included in the analysis. We evaluated the effect of treatment assignment on mortality, after adjusting for biases using a Cox proportional hazards model that included inverse probability of treatment weighting and surgery as a time-dependent covariate. The cohort was stratified by probability (propensity) for surgery, and outcomes were compared between the treatment groups within each stratum. INTERVENTIONS: Valve replacement during index hospitalization (early surgery) vs medical therapy. MAIN OUTCOMES AND MEASURES: In-hospital and 1-year mortality. RESULTS: Of the 1025 patients with PVE, 490 patients (47.8%) underwent early surgery and 535 individuals (52.2%) received medical therapy alone. Compared with medical therapy, early surgery was associated with lower in-hospital mortality in the unadjusted analysis and after controlling for treatment selection bias (in-hospital mortality: hazard ratio [HR], 0.44 [95% CI, 0.38-0.52] and lower 1-year mortality: HR, 0.57 [95% CI, 0.49-0.67]). The lower mortality associated with surgery did not persist after adjustment for survivor bias (in-hospital mortality: HR, 0.90 [95% CI, 0.76-1.07] and 1-year mortality: HR, 1.04 [95% CI, 0.89-1.23]). Subgroup analysis indicated a lower in-hospital mortality with early surgery in the highest surgical propensity quintile (21.2% vs 37.5%; P = .03). At 1-year follow-up, the reduced mortality with surgery was observed in the fourth (24.8% vs 42.9%; P = .007) and fifth (27.9% vs 50.0%; P = .007) quintiles of surgical propensity. CONCLUSIONS AND RELEVANCE: Prosthetic valve endocarditis remains associated with a high 1-year mortality rate. After adjustment for differences in clinical characteristics and survival bias, early valve replacement was not associated with lower mortality compared with medical therapy in the overall cohort. Further studies are needed to define the effect and timing of surgery in patients with PVE who have indications for surgery.
Language eng
DOI 10.1001/jamainternmed.2013.8203
Field of Research 119999 Medical and Health Sciences not elsewhere classified
Socio Economic Objective 929999 Health not elsewhere classified
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2013, American Medical Association
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Document type: Journal Article
Collection: School of Medicine
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