Mazzotta Ruggero, Orlandi Matteo, Scheggi Valentina, Marchionni Niccolò, Stefàno Pierluigi
Division of General Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy.
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
PLoS One. 2024 Dec 4;19(12):e0314718. doi: 10.1371/journal.pone.0314718. eCollection 2024.
Septic embolization is a common and potentially life-threatening complication of infective endocarditis (IE), with a prevalence of 22-50%. While acute coronary syndrome secondary to septic embolism is rare, it poses significant risks.
This study examines coronary embolism (CE) in left-sided IE, describing clinical characteristics and outcomes.
We retrospectively analysed 649 patients with non-device-related left-sided IE treated between January 2013 and December 2023 in a high-volume surgical centre. CE was diagnosed via ECG, clinical and laboratory signs of acute coronary syndrome, and confirmed by coronary angiography or magnetic resonance imaging. All patients were treated according to current European Society of Cardiology guidelines. A structured follow-up was performed.
Among patients included in the study, surgery was performed in 514 (79%) patients. Median follow-up duration was 4.7 years. CE occurred in 8 (1.2%) patients, and 6 (80%) of them were treated surgically. We found no significant differences in overall mortality rate between patients with or without CE (p = 0.65). Finally, cerebral embolism was significantly more frequent in patients with than without CE (75% vs 25%, p = 0.006, post-hoc power 87.8%).
CE is a rare but severe complication of IE, significantly associated with cerebral embolism. Early recognition and treatment are crucial to improve patient outcomes. Multicentre studies with larger patient populations are needed to further elucidate risk factors and enhance prognosis for CE in IE patients.
脓毒性栓塞是感染性心内膜炎（IE）常见且可能危及生命的并发症，发生率为22%-50%。虽然脓毒性栓塞继发的急性冠状动脉综合征很少见，但风险很大。
本研究调查左侧IE中的冠状动脉栓塞（CE），描述其临床特征和结局。
我们回顾性分析了2013年1月至2023年12月在一家大型外科中心接受治疗的649例非器械相关左侧IE患者。通过急性冠状动脉综合征的心电图、临床和实验室检查结果诊断CE，并通过冠状动脉造影或磁共振成像确诊。所有患者均按照当前欧洲心脏病学会指南进行治疗。进行了结构化随访。
在纳入研究的患者中，514例（79%）接受了手术。中位随访时间为4.7年。8例（1.2%）患者发生CE，其中6例（80%）接受了手术治疗。我们发现有或无CE患者的总死亡率无显著差异（p = 0.65）。最后，有CE的患者发生脑栓塞的频率显著高于无CE的患者（75%对25%，p = 0.006，事后检验效能87.8%）。
CE是IE罕见但严重的并发症，与脑栓塞显著相关。早期识别和治疗对改善患者结局至关重要。需要开展更大规模患者群体的多中心研究，以进一步阐明危险因素并改善IE患者CE的预后。
