Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark.
Eur Heart J. 2024 Nov 21;45(44):4704-4715. doi: 10.1093/eurheartj/ehae548.
Patients with congenital heart disease (CHD) form a high-risk subgroup for infective endocarditis (IE), necessitating tailored prevention and treatment strategies. However, comprehensive nationwide data comparing IE characteristics and outcomes in patients with and without CHD, including children, are sparse. This study aims to address this gap in knowledge.
Using Danish nationwide registries, all patients with IE from 1977 to 2021 were identified and stratified on whether they had a diagnosis of CHD, regardless of its complexity. Characteristics prior to and during admission as well as associated outcomes (i.e. in-hospital mortality, 1-year mortality, and 10-year mortality, and IE recurrence) were compared between groups.
In total, 14 040 patients with IE were identified, including 895 (6.4%) with CHD. Patients with vs. without CHD were younger at the time of IE diagnosis (median age 38.8 vs. 70.7 years), less comorbid, and more frequently underwent cardiac surgery during admission (35.7% vs. 23.0%, P < .001). Notably, 76% of patients with IE < 18 years of age had CHD. The IE-related bacteraemia differed between groups: Streptococci (29.9%) were the most common in patients with CHD, and Staphylococcus aureus (29.9%) in patients without CHD. Patients with CHD had a significantly lower cumulative incidence of in-hospital mortality (5.7% vs. 17.0%, P < .001) and 1-year mortality (9.9% vs. 31.8%, P < .001) compared with those without CHD. The 10-year cumulative incidence of IE recurrence was similar between groups (13.0% and 13.9%, P = .61).
Patients with CHD who develop IE exhibit distinct characteristics and improved long-term outcomes compared with patients without CHD. Notably, the majority of children and adolescents with IE have underlying CHD.
患有先天性心脏病 (CHD) 的患者是感染性心内膜炎 (IE) 的高危亚组，需要制定针对性的预防和治疗策略。然而，关于患有和不患有 CHD 的患者（包括儿童在内）的 IE 特征和结局的全面全国性数据很少。本研究旨在填补这一知识空白。
使用丹麦全国性登记处，确定了 1977 年至 2021 年间所有 IE 患者，并根据他们是否患有 CHD 进行分层，无论其复杂程度如何。比较了两组患者入院前和入院期间的特征以及相关结局（即住院死亡率、1 年死亡率和 10 年死亡率以及 IE 复发）。
共确定了 14040 例 IE 患者，其中 895 例（6.4%）患有 CHD。与无 CHD 的患者相比，患有 CHD 的患者在 IE 诊断时年龄更小（中位数年龄为 38.8 岁 vs. 70.7 岁），合并症更少，并且在入院期间更频繁地接受心脏手术（35.7% vs. 23.0%，P <.001）。值得注意的是，76%的<18 岁 IE 患者患有 CHD。两组 IE 相关菌血症不同：CHD 患者中最常见的病原体是链球菌（29.9%），无 CHD 的患者中最常见的病原体是金黄色葡萄球菌（29.9%）。与无 CHD 的患者相比，患有 CHD 的患者的住院死亡率（5.7% vs. 17.0%，P <.001）和 1 年死亡率（9.9% vs. 31.8%，P <.001）明显更低。两组 10 年 IE 复发累积发生率相似（13.0%和 13.9%，P =.61）。
患有 CHD 的 IE 患者与不患有 CHD 的患者相比，具有不同的特征和更好的长期结局。值得注意的是，大多数患有 IE 的儿童和青少年都有潜在的 CHD。
