Heart Center, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 8, KBH N, Denmark.
Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark.
Eur Heart J. 2019 May 1;40(17):1355-1361. doi: 10.1093/eurheartj/ehy629.
Stratification of patients at risk of infective endocarditis (IE) remains a cornerstone in guidance of prophylactic strategies of IE. However, little attention has been given to patients considered at moderate risk.
Using Danish nationwide registries, we assessed the risk of IE in patients with aortic and mitral valve disorders, a cardiac implantable electronic device (CIED), or hypertrophic cardiomyopathy (HCM) and compared these patient groups with (i) controls from the background population using risk-set matching and (ii) a high-risk population (prosthetic heart valve). Cumulative incidence plots and multivariable adjusted Cox proportional hazard analysis were used to compare risk of IE between risk groups. We identified 83 453 patients with aortic or mitral valve disorder, 50 828 with a CIED, and 3620 with HCM. The cumulative risk of IE after 10 years was 0.9% in valve disorder, 1.3% in CIED, and 0.5% in HCM patients. Compared with the background population, valve disorder, CIED, and HCM carried a higher associated risk of IE, hazard ratio (HR) = 8.75 [95% confidence interval (CI) 6.36-12.02], HR = 6.63 (95% CI 4.41-9.96), and HR = 6.57 (95% CI 2.33-18.56), respectively. All three study groups were associated with a lower risk of IE compared with high-risk patients, HR = 0.27 (95% CI 0.23-0.32) for valve disorder, HR = 0.28 (95% CI 0.23-0.33) for CIED, and HR = 0.13 (95% CI 0.06-0.29) for HCM.
Heart valve disorder, CIED, and patients with HCM were associated with a higher risk of IE compared with the background population but have a lower associated risk of IE compared with high-risk patients.
对感染性心内膜炎（IE）风险患者进行分层仍然是指导 IE 预防策略的基石。然而，对于处于中度风险的患者，关注甚少。
我们使用丹麦全国性登记处，评估了主动脉瓣和二尖瓣疾病、心脏植入式电子设备（CIED）或肥厚型心肌病（HCM）患者的 IE 风险，并将这些患者与（i）使用风险集匹配的背景人群对照，以及（ii）高风险人群（人工心脏瓣膜）进行比较。累积发病率图和多变量调整 Cox 比例风险分析用于比较风险组之间的 IE 风险。我们确定了 83453 例主动脉瓣或二尖瓣疾病患者、50828 例 CIED 患者和 3620 例 HCM 患者。10 年后，瓣膜疾病、CIED 和 HCM 患者的 IE 累积风险分别为 0.9%、1.3%和 0.5%。与背景人群相比，瓣膜疾病、CIED 和 HCM 发生 IE 的风险更高，风险比（HR）分别为 8.75（95%置信区间[CI] 6.36-12.02）、6.63（95% CI 4.41-9.96）和 6.57（95% CI 2.33-18.56）。所有三组患者的 IE 风险均低于高危患者，瓣膜疾病患者的 HR 为 0.27（95% CI 0.23-0.32），CIED 患者的 HR 为 0.28（95% CI 0.23-0.33），HCM 患者的 HR 为 0.13（95% CI 0.06-0.29）。
与背景人群相比，心脏瓣膜疾病、CIED 和 HCM 患者发生 IE 的风险更高，但与高危患者相比，IE 风险较低。
