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

Barsic, Bruno, Dickerman, Stuart, Krajinovic, Vladimir, Pappas, Paul, Altclas, Javier, Carosi, Giampiero, Casabé, Jose H., Chu, Vivian H., Delahaye, Francois, Edathodu, Jameela, Fortes, Claudio Querido, Olaison, Lars, Pangercic, Ana, Patel, Mukesh, Rudez, Igor, Tamin, Syahidah Syed, Vincelj, Josip, Bayer, Arnold S., Wang, Andrew, Anstrom, Kevin, Athan, Eugene, Cabell, Christopher H., Corey, G. Ralph, Fowler Jr, Vance G., Hoen, Bruno, Karchmer, A. W., Miro, Jose M., Murdoch, David R. and Sexton, Daniel J. 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, doi: 10.1093/cid/cis878.

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Title Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke
Author(s) Barsic, Bruno
Dickerman, Stuart
Krajinovic, Vladimir
Pappas, Paul
Altclas, Javier
Carosi, Giampiero
Casabé, Jose H.
Chu, Vivian H.
Delahaye, Francois
Edathodu, Jameela
Fortes, Claudio Querido
Olaison, Lars
Pangercic, Ana
Patel, Mukesh
Rudez, Igor
Tamin, Syahidah Syed
Vincelj, Josip
Bayer, Arnold S.
Wang, Andrew
Anstrom, Kevin
Athan, EugeneORCID iD for Athan, Eugene
Cabell, Christopher H.
Corey, G. Ralph
Fowler Jr, Vance G.
Hoen, Bruno
Karchmer, A. W.
Miro, Jose M.
Murdoch, David R.
Sexton, Daniel J.
Journal name Clinical infectious diseases
Volume number 56
Issue number 2
Start page 209
End page 217
Total pages 9
Publisher Oxford University Press
Place of publication Oxford, Eng.
Publication date 2013
ISSN 1058-4838
Keyword(s) Adult
Cardiac Surgical Procedures
Cohort Studies
Hospital Mortality
Middle Aged
Time Factors
International Collaboration on Endocarditis–Prospective Cohort Study Investigators
Summary 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.
Language eng
DOI 10.1093/cid/cis878
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 ©2012, The Authors
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