Influence of the Timing of Cardiac Surgery on the Outcome of Patients With Infective Endocarditis and Stroke
Open accessAbstract
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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- Authors
- Barsic, B., Dickerman, S., Krajinovic, V., Pappas, P., Altclas, J., Carosi, G., Casabé, J. H., Chu, V. H., Delahaye, F., Edathodu, J., Fortes, C. Q., Olaison, L., Pangercic, A., Patel, M., Rudez, I., Tamin, S. S., Vincelj, J., Bayer, A. S., Wang, A., & for the International Collaboration on Endocarditis–Prospective Cohort Study (ICE-PCS) Investigators
- Affiliations
- Hospital for Infectious Diseases, School of Medicine, Zagreb, Croatia
- New York University (US)
- Duke Medical Center (US)
- Barcelona Centre for International Health Research, Spain
- University of Brescia (IT)
- Favaloro Foundation (AR)
- Hopital Louis Pradel, Lyon, France
- King Faisal Specialist Hospital & Research Centre (SA)
- Clementino Fraga Filho Hospital, Rio de Janeiro, Brazil
- Sahlgrenska University Hospital (SE)
- University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
- University of Alabama at Birmingham (US)
- Dubrava University Hospital, Zagreb, Croatia
- National Heart Institute (MY)
- University Hospital Dubrava (HR)
- University of California, Los Angeles (US)
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-10-16
- Volume
- 56
- Issue
- 2
- Pages
- 209-217
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2101319655
- Semantic Scholar
- 7f5618ec8727be14c2968405500c15e20bfb9f7d
- Cited by
- 157
- References
- 33
- Citations by year
- 2026: 2 · 2025: 8 · 2024: 17 · 2023: 7 · 2022: 3 · 2021: 13 · 2020: 9 · 2019: 17 · 2018: 14 · 2017: 10 · 2016: 18 · 2015: 13 · 2014: 18 · 2013: 8
- FWCI
- 9.34
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- ResearchOnline - JCU (James Cook University) (submittedVersion)
- HAL (submittedVersion)
- Institutional Research Information System (University of Udine) (submittedVersion)
- Universitätsbibliographie, Universität Duisburg-Essen (submittedVersion)
- Figshare (submittedVersion, cc-by)
- IrInSubria (University of Insubria) (submittedVersion)
- IRIS (submittedVersion)
- Universidad de Chile (submittedVersion, cc-by-nc-nd)
- SERVAL (Université de Lausanne) (submittedVersion)
- Funders
- Pfizer
- American College of Cardiology Foundation
- Gilead Sciences
- Astellas Pharma
- Abbott Vascular
- Topics
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Streptococcal Infections and Treatments
- Keywords
- infective endocarditis, ischemic stroke, timing of cardiac surgery, valve replacement, early surgical intervention, delayed surgery, in-hospital mortality, one-year mortality
- MeSH terms
- Adult, Aged, Endocarditis, Female, Cardiac Surgical Procedures, Humans, Inpatients, Male, Middle Aged, Time Factors, Cohort Studies, Hospital Mortality, Stroke
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