Anantha Narayanan Mahesh, Mahfood Haddad Toufik, Kalil Andre C, Kanmanthareddy Arun, Suri Rakesh M, Mansour George, Destache Christopher J, Baskaran Janani, Mooss Aryan N, Wichman Tammy, Morrow Lee, Vivekanandan Renuga
Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA.
Division of Infectious Diseases, University of Nebraska School of Medicine, Omaha, Nebraska, USA.
Heart. 2016 Jun 15;102(12):950-7. doi: 10.1136/heartjnl-2015-308589. Epub 2016 Feb 11.
Infective endocarditis is associated with high morbidity and mortality and optimal timing for surgical intervention is unclear. We performed a systematic review and meta-analysis to compare early surgical intervention with conservative therapy in patients with infective endocarditis.
PubMed, Cochrane, EMBASE, CINAHL and Google-scholar databases were searched from January 1960 to April 2015. Randomised controlled trials, retrospective cohorts and prospective observational studies comparing outcomes between early surgery at 20 days or less and conservative management for infective endocarditis were analysed.
A total of 21 studies were included. OR of all-cause mortality for early surgery was 0.61 (95% CI 0.50 to 0.74, p<0.001) in unmatched groups and 0.41 (95% CI 0.31 to 0.54, p<0.001) in the propensity-matched groups (matched for baseline variables). For patients who had surgical intervention at 7 days or less, OR of all-cause mortality was 0.61 (95% CI 0.39 to 0.96, p=0.034) and in those who had surgical intervention within 8-20 days, the OR of mortality was 0.64 (95% CI 0.48 to 0.86, p=0.003) compared with conservative management. In propensity-matched groups, the OR of mortality in patients with surgical intervention at 7 days or less was 0.30 (95% CI 0.16 to 0.54, p<0.001) and in the subgroup of patients who underwent surgery between 8 and 20 days was 0.51 (95% CI 0.35 to 0.72, p<0.001). There was no significant difference in in-hospital mortality, embolisation, heart failure and recurrence of endocarditis between the overall unmatched cohorts.
The results of our meta-analysis suggest that early surgical intervention is associated with significantly lower risk of mortality in patients with infective endocarditis.
感染性心内膜炎与高发病率和高死亡率相关，手术干预的最佳时机尚不清楚。我们进行了一项系统评价和荟萃分析，以比较感染性心内膜炎患者早期手术干预与保守治疗的效果。
检索了1960年1月至2015年4月期间的PubMed、Cochrane、EMBASE、CINAHL和谷歌学术数据库。分析了比较20天及以内的早期手术与感染性心内膜炎保守治疗效果的随机对照试验、回顾性队列研究和前瞻性观察性研究。
共纳入21项研究。在未匹配组中，早期手术的全因死亡率OR为0.61（95%CI 0.50至0.74，p<0.001），在倾向匹配组（根据基线变量匹配）中为0.41（95%CI 0.31至0.54，p<0.001）。对于在7天及以内接受手术干预的患者，与保守治疗相比，全因死亡率OR为0.61（95%CI 0.39至0.96，p=0.034）；对于在8-20天内接受手术干预的患者，死亡率OR为0.64（95%CI 0.48至0.86，p=0.003）。在倾向匹配组中，7天及以内接受手术干预的患者死亡率OR为0.30（95%CI 0.16至0.54，p<0.001），8至20天接受手术的亚组患者死亡率OR为0.51（95%CI 0.35至0.72，p<0.001）。在总体未匹配队列中，住院死亡率、栓塞、心力衰竭和心内膜炎复发方面无显著差异。
我们的荟萃分析结果表明，早期手术干预与感染性心内膜炎患者的死亡率显著降低相关。
