Department of Internal Medicine, Hospital Central "Dr. Ignacio Morones Prieto", San Luis Potosí; México.
Department of Cardiology, Hospital Central "Dr. Ignacio Morones Prieto", San Luis Potosí; México.
Arch Cardiol Mex. 2021 Nov 1;91(4):458-464. doi: 10.24875/ACM.200004011.
Early surgical procedures on patients with infective endocarditis (IE) have shown a clearly benefit to reduce embolization at the central nervous system. We conducted a retrospective cohort in Mexican population to evaluate mortality and clinical outcomes in patients with IE with or without surgical intervention.
Our aim was to evaluate factors associated with mortality in patients with IE and compare both groups with and without a surgical intervention.
We evaluated a retrospective cohort of patients who had been diagnosed with IE according to the Duke's criteria at our Institution in SLP, Mexico, from January 2001 to September 2016. We compared the risk factors associated to mortality of patients with or without surgery. Our primary outcome was mortality within 6 months of follow-up after the diagnosis.
We included 105 patients, 51 (48.6%) were men, median age 46 [Q1 30, Q3 59] years, 36 patients (34.3%) received surgical treatment (STG), and 69 (65.7%) only medical treatment (MTG) group; 41 patients (39%) died during the study period; in the surgery group eight patients died (22%); and 33 in the MT group (47%) p = 0.049. Adjusted for APACHE II, surgery, creatinine levels and the size of vegetation, the surgery group had lower mortality than patients on MTG (HR 0.36, p = 0.047).
As previously described in the literature, patients who underwent surgery had lower mortality than the patients who only received medical treatment; however, the Mexican population is different to other populations group, due to higher risk of diabetes mellitus (28%) versus (10%) in global risk of DM in the world and its complications and other chronic diseases as arterial systemic hypertension. Thus, surgical treatment must be elected as goal standard treatment in patient's whit IE and presence of vegetation.
早期对感染性心内膜炎（IE）患者的手术治疗已明显降低了中枢神经系统栓塞的风险。我们在墨西哥人群中进行了一项回顾性队列研究，以评估有或无手术干预的 IE 患者的死亡率和临床结局。
我们旨在评估 IE 患者死亡的相关因素，并比较有和无手术干预的两组患者。
我们评估了 2001 年 1 月至 2016 年 9 月在墨西哥 SLP 的我们机构根据 Duke 标准诊断为 IE 的患者的回顾性队列。我们比较了有和无手术的患者与死亡率相关的危险因素。我们的主要结局是诊断后 6 个月内的死亡率。
我们纳入了 105 例患者，其中 51 例（48.6%）为男性，中位年龄 46[Q1 30，Q3 59]岁，36 例（34.3%）接受了手术治疗（STG），69 例（65.7%）仅接受了药物治疗（MTG）；研究期间有 41 例（39%）患者死亡；手术组有 8 例死亡（22%）；MT 组有 33 例（47%），p = 0.049。校正 APACHE II、手术、肌酐水平和赘生物大小后，手术组的死亡率低于 MTG 组（HR 0.36，p = 0.047）。
与文献中先前描述的情况一样，接受手术的患者死亡率低于仅接受药物治疗的患者；然而，与全球糖尿病风险（10%）相比，墨西哥人群的糖尿病风险更高（28%）及其并发症和其他慢性疾病如全身动脉高血压，这导致人群不同。因此，手术治疗必须作为 IE 合并赘生物患者的标准治疗方案。
