Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
J Thorac Cardiovasc Surg. 2016 Sep;152(3):832-841.e1. doi: 10.1016/j.jtcvs.2016.02.072. Epub 2016 Mar 12.
With increasing prevalence of injected drug use in the United States, a growing number of intravenous drug users (IVDUs) are at risk for infective endocarditis (IE) that may require surgical intervention; however, few data exist about clinical outcomes of these individuals.
We evaluated consecutive adult patients undergoing surgery for active IE between 2002 and 2014 pooled from 2 prospective institutional databases. Death and valve-related events, including reinfection or heart valve reoperation, thromboembolism, and anticoagulation-related hemorrhage were evaluated.
Of the 436 patients identified, 78 (17.9%) were current IVDUs. The proportion of IVDUs increased from 14.8% in 2002 to 2004 to 26.1% in 2012 to 2014. IVDUs were younger (aged 35.9 ± 9.9 years vs 59.3 ± 14.1 years) and had fewer cardiovascular risk factors than non-IVDUs. During follow-up (median, 29.4 months; quartile 1-3, 4.7-72.6 months), adverse events among all patients included death in 92, reinfection in 42, valve-reoperation in 35, thromboembolism in 17, and hemorrhage in 16. Operative mortality was lower among IVDUs (odds ratio, 0.25; 95% confidence interval [CI], 0.06-0.71), but overall mortality was not significantly different (hazard ratio [HR], 0.78; 95% CI, 0.44-1.37). When baseline profiles were adjusted by propensity score, IVDUs had higher risk of valve-related complications (HR, 3.82; 95% CI, 1.95-7.49; P < .001) principally attributable to higher rates of reinfection (HR, 6.20; 95% CI, 2.56-15.00; P < .001).
The proportion of IVDUs among surgically treated IE patients is increasing. Although IVDUs have lower operative risk, long-term outcomes are compromised by reinfection.
随着美国注射吸毒人群的不断增加，越来越多的静脉药物使用者（IVDUs）面临感染性心内膜炎（IE）的风险，可能需要手术干预；然而，关于这些患者的临床结局的数据很少。
我们评估了 2002 年至 2014 年期间，从 2 个前瞻性机构数据库中收集的连续接受手术治疗的活动性 IE 成年患者。评估了死亡和与瓣膜相关的事件，包括再感染或心脏瓣膜再次手术、血栓栓塞和抗凝相关出血。
在确定的 436 名患者中，78 名（17.9%）是当前的 IVDUs。IVDUs 的比例从 2002 年至 2004 年的 14.8%增加到 2012 年至 2014 年的 26.1%。IVDUs 更年轻（年龄 35.9±9.9 岁 vs 59.3±14.1 岁），心血管危险因素较少。在随访期间（中位数 29.4 个月；四分位数 1-3，4.7-72.6 个月），所有患者的不良事件包括 92 例死亡、42 例再感染、35 例瓣膜再次手术、17 例血栓栓塞和 16 例出血。IVDUs 的手术死亡率较低（比值比，0.25；95%置信区间[CI]，0.06-0.71），但总体死亡率无显著差异（风险比[HR]，0.78；95%CI，0.44-1.37）。当通过倾向评分调整基线特征时，IVDUs 发生瓣膜相关并发症的风险更高（HR，3.82；95%CI，1.95-7.49；P<.001），主要归因于再感染率较高（HR，6.20；95%CI，2.56-15.00；P<.001）。
接受手术治疗的 IE 患者中 IVDUs 的比例正在增加。虽然 IVDUs 的手术风险较低，但再感染会导致长期预后受损。
