Efficacy of Primary Surgical Versus Medical Intervention for Treatment of Left-Sided Infective Endocarditis.

Aged Endocarditis, Bacterial / drug therapy Female Heart Valve Prosthesis Implantation / methods Humans Male Middle Aged Proportional Hazards Models Retrospective Studies

Journal

The Annals of thoracic surgery
ISSN: 1552-6259
Titre abrégé: Ann Thorac Surg
Pays: Netherlands
ID NLM: 15030100R

Informations de publication

Date de publication:
11 2020
Historique:
received: 13 11 2019
revised: 06 03 2020
accepted: 16 03 2020
pubmed: 22 4 2020
medline: 15 12 2020
entrez: 22 4 2020
Statut: ppublish

Résumé

Left-sided staphylococcal, streptococcal, and enterococcal infective endocarditis (IE) is associated with poor clinical outcomes. Our primary aim is to compare clinical outcomes of staphylococcal, streptococcal, and enterococcal IE patients who undergo valve replacement surgery and outcomes of patients who are treated solely with antibiotics. All patients were treated medically or surgically for left-sided staphylococcal, streptococcal, or enterococcal IE at our institution from 1998 to 2014 and were retrospectively studied. The primary outcome of interest was 30-day and 1-year mortality, and secondary outcomes included posttreatment septic shock, embolic events, stroke, and end-stage renal disease at 30 days. Inverse probability treatment weights, derived from propensity scores, were used to balance the medical and surgical cohorts across clinical risk factors, The Society of Thoracic Surgeon scores, and pathogens. Outcomes were compared comprehensively and in a staphylococcal-only subanalysis. Study population consisted of 245 surgical patients and 164 medical patients. Mortality at 30 days was higher in the medical cohort, both in aggregate and for staphylococcal only (all, 7% vs 16%, P < .001; staphylococcal only, 7% vs 22%, P < .001). Surgical patients had a higher incidence of septic shock and renal dysfunction; however, stroke and embolic events at 30 days were not different between cohorts. Cox survival analysis demonstrated that surgical treatment provided a 1-year survival benefit, with a hazard ratio of 0.48 (95% confidence interval, 0.36 to 0.64) that was robust regardless of pathogen. Compared with medical management, valve replacement surgery in patients with left-sided staphylococcal, streptococcal, or enterococcal IE appears to confer a survival advantage at 30 days and 1 year.

Sections du résumé

BACKGROUND
Left-sided staphylococcal, streptococcal, and enterococcal infective endocarditis (IE) is associated with poor clinical outcomes. Our primary aim is to compare clinical outcomes of staphylococcal, streptococcal, and enterococcal IE patients who undergo valve replacement surgery and outcomes of patients who are treated solely with antibiotics.
METHODS
All patients were treated medically or surgically for left-sided staphylococcal, streptococcal, or enterococcal IE at our institution from 1998 to 2014 and were retrospectively studied. The primary outcome of interest was 30-day and 1-year mortality, and secondary outcomes included posttreatment septic shock, embolic events, stroke, and end-stage renal disease at 30 days. Inverse probability treatment weights, derived from propensity scores, were used to balance the medical and surgical cohorts across clinical risk factors, The Society of Thoracic Surgeon scores, and pathogens. Outcomes were compared comprehensively and in a staphylococcal-only subanalysis.
RESULTS
Study population consisted of 245 surgical patients and 164 medical patients. Mortality at 30 days was higher in the medical cohort, both in aggregate and for staphylococcal only (all, 7% vs 16%, P < .001; staphylococcal only, 7% vs 22%, P < .001). Surgical patients had a higher incidence of septic shock and renal dysfunction; however, stroke and embolic events at 30 days were not different between cohorts. Cox survival analysis demonstrated that surgical treatment provided a 1-year survival benefit, with a hazard ratio of 0.48 (95% confidence interval, 0.36 to 0.64) that was robust regardless of pathogen.
CONCLUSIONS
Compared with medical management, valve replacement surgery in patients with left-sided staphylococcal, streptococcal, or enterococcal IE appears to confer a survival advantage at 30 days and 1 year.

Identifiants

DOI: 10.1016/j.athoracsur.2020.03.047 PMID: 32315643
pubmed: 32315643
pii: S0003-4975(20)30573-7
doi: 10.1016/j.athoracsur.2020.03.047
pii:
doi:

Types de publication

Comparative Study Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1615-1621

Commentaires et corrections

Type : CommentIn
Type : CommentIn

Informations de copyright

Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Auteurs

Stergios Gatzoflias (S)

Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York.

Matthew A Beier (MA)

Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York.

Yuming Ning (Y)

Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Medical Center, New York, New York.

Alex Kossar (A)

Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York.

Marcia Gailes (M)

Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York.

Karina Guaman (K)

Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York.

Michal Segall (M)

Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York.

Anisha Vasireddi (A)

Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York.

Catherine Wang (C)

Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York.

Koji Takeda (K)

Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York.

Hiroo Takayama (H)

Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York.

Vinayak Bapat (V)

Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York.

Yoshifumi Naka (Y)

Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York.

Michael Argenziano (M)

Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York.

Craig R Smith (CR)

Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York.

Rachel Gordon (R)

Department of Medicine, Columbia University Medical Center, New York, New York; Department of Epidemiology, Columbia University Medical Center, New York, New York.

Jose Gutierrez (J)

Department of Neurology, Columbia University Medical Center, New York, New York.

Paul Kurlansky (P)

Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York; Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Medical Center, New York, New York.

Isaac George (I)

Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York. Electronic address: ig2006@cumc.columbia.edu.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Efficacy of Primary Surgical Versus Medical...
questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Endocardite › Endocardite bactérienne › Efficacy of Primary Surgical Versus Medical...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie thoracique › Procédures de chirurgie cardiaque › Implantation de valve prothétique cardiaque › Efficacy of Primary Surgical Versus Medical...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Efficacy of Primary Surgical Versus Medical...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Efficacy of Primary Surgical Versus Medical...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Analyse de survie › Modèles des risques proportionnels › Efficacy of Primary Surgical Versus Medical...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Efficacy of Primary Surgical Versus Medical...