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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 Françoise ; Wang, Andrew

JAMA internal medicine, 2013-09, Vol.173 (16), p.1495-1504 [Periódico revisado por pares]

Chicago, IL: American Medical Association

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Título:
In-Hospital and 1-Year Mortality in Patients Undergoing Early Surgery for Prosthetic Valve Endocarditis
Autor: 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 Françoise ; Wang, Andrew
Assuntos: Aortic Valve ; Aortic Valve - surgery ; Biological and medical sciences ; Endocarditis, Bacterial ; Endocarditis, Bacterial - mortality ; Endocarditis, Bacterial - therapy ; Epidemiology ; Female ; Follow-Up Studies ; General aspects ; Heart Valve Prosthesis ; Heart Valve Prosthesis - adverse effects ; Heart Valve Prosthesis Implantation ; Hospital Mortality ; Human health and pathology ; Humans ; Infectious Medicine ; Infektionsmedicin ; Life Sciences ; Male ; Medical sciences ; Middle Aged ; Miscellaneous ; Mitral Valve ; Mitral Valve - surgery ; Propensity Score ; Proportional Hazards Models ; Prospective Studies ; Prosthesis-Related Infections ; Prosthesis-Related Infections - mortality ; Prosthesis-Related Infections - therapy ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Registries ; Time-to-Treatment
É parte de: JAMA internal medicine, 2013-09, Vol.173 (16), p.1495-1504
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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Descrição: 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.
Editor: Chicago, IL: American Medical Association
Idioma: Inglês

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In-Hospital and 1-Year Mortality in Patients Undergoing Early Surgery for Prosthetic Valve Endocarditis

Chicago, IL: American Medical Association

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