Gálvez-Acebal Juan, Almendro-Delia Manuel, Ruiz Josefa, de Alarcón Arístides, Martínez-Marcos Francisco J, Reguera José M, Ivanova-Georgieva Radka, Noureddine Mariam, Plata Antonio, Lomas José M, de la Torre-Lima Javier, Hidalgo-Tenorio Carmen, Luque Rafael, Rodríguez-Baño Jesús
Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena, Seville, Spain; Department of Medicine, University of Sevilla, Seville, Spain.
Cardiology Service, University Hospital Virgen Macarena, Seville, Spain.
Mayo Clin Proc. 2014 Oct;89(10):1397-405. doi: 10.1016/j.mayocp.2014.06.021. Epub 2014 Aug 30.
To analyze the influence of early valve operation on mortality in patients with left-sided infective endocarditis (IE).
A multicenter cohort study was carried out between 1990 and 2010. Data from consecutive patients with definite IE and possible left-sided IE were collected. Propensity score matching and adjustment for survivor bias were used to control for confounders. The primary outcome was in-hospital mortality.
A total of 1019 patients with a mean age of 61 years (interquartile range, 47-71 years) were included. Early surgical treatment was performed in 417 episodes (40.9%). By propensity score, we matched 316 episodes: 158 who underwent early surgical treatment and 158 who did not (medical treatment group). In-hospital mortality and late mortality were lower in the surgically treated group (26.6% vs 41.8%; absolute risk reduction [ARR], -15.2%; P=.004 and 29.7% vs 46.2%; ARR, -16.5%; P=.002, respectively). Operation was independently associated with a lower risk of in-hospital mortality (odds ratio, 0.42; 95% CI, 0.22-0.79; P=.007). Operation was associated with reduced mortality in patients with paravalvular complications (ARR, -40.5%), severe heart failure (ARR, -32%), and native valve endocarditis (ARR, -17.8%).
This study supports the benefit of surgical treatment in patients with left-sided IE carried out during the initial phase of hospitalization, especially in patients with moderate or severe heart failure and paravalvular extension of infection.
分析早期瓣膜手术对左侧感染性心内膜炎（IE）患者死亡率的影响。
1990年至2010年开展了一项多中心队列研究。收集了连续确诊IE和可能为左侧IE患者的数据。采用倾向评分匹配和对生存偏倚进行调整来控制混杂因素。主要结局为住院死亡率。
共纳入1019例患者，平均年龄61岁（四分位间距，47 - 71岁）。417例（40.9%）进行了早期手术治疗。通过倾向评分，我们匹配了316例：158例接受早期手术治疗，158例未接受（药物治疗组）。手术治疗组的住院死亡率和晚期死亡率较低（分别为26.6%对41.8%；绝对风险降低[ARR]，-15.2%；P = 0.004；以及29.7%对46.2%；ARR，-16.5%；P = 0.002）。手术独立与较低的住院死亡风险相关（比值比为0.42；95%可信区间，0.22 - 0.79；P = 0.007）。手术与瓣周并发症患者（ARR，-40.5%）、严重心力衰竭患者（ARR，-32%）和自体瓣膜心内膜炎患者（ARR，-17.8%）死亡率降低相关。
本研究支持对住院初期的左侧IE患者进行手术治疗的益处，尤其是对中度或重度心力衰竭以及感染有瓣周扩展的患者。
