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JAMA Intern Med. 2013 Sep 9;173(16):1495-504. doi: 10.1001/jamainternmed.2013.8203.

In-hospital and 1-year mortality in patients undergoing early surgery for prosthetic valve endocarditis.

Collaborators (325)

Clara L, Sanchez M, Casabé J, Cortes C, Nacinovich F, Oses PF, Ronderos R, Sucari A, Thierer J, Altclas J, Kogan S, Spelman D, Athan E, Harris O, Kennedy K, Tan R, Gordon D, Papanicolas L, Eisen D, Grigg L, Street A, Korman T, Kotsanas D, Dever R, Jones P, Konecny P, Lawrence R, Rees D, Ryan S, Feneley MP, Harkness J, Jones P, Ryan S, Jones P, Ryan S, Jones P, Post J, Reinbott P, Ryan S, Gattringer R, Wiesbauer F, Andrade AR, de Brito AC, Guimarães AC, Grinberg M, Mansur AJ, Siciliano RF, Strabelli TM, Vieira ML, Tranchesi RA, Paiva MG, Fortes CQ, Ramos Ade O, Ferraiuoli G, Golebiovski W, Lamas C, Weksler C, Santos M, Karlowsky JA, Keynan Y, Morris AM, Rubinstein E, Jones SB, Garcia P, Cereceda M, Fica A, Mella RM, Fernandez R, Franco L, Gonzalez J, Jaramillo AN, Barsic B, Bukovski S, Krajinovic V, Pangercic A, Rudez I, Vincelj J, Freiberger T, Pol J, Zaloudikova B, Ashour Z, El Kholy A, Mishaal M, Osama D, Rizk H, Aissa N, Alauzet C, Alla F, Campagnac C, Doco-Lecompte T, Selton-Suty C, Casalta JP, Fournier PE, Habib G, Raoult D, Thuny F, Delahaye F, Delahaye A, Vandenesch F, Donal E, Donnio PY, Flecher E, Michelet C, Revest M, Tattevin P, Chevalier F, Jeu A, Rémadi JP, Rusinaru D, Tribouilloy C, Bernard Y, Chirouze C, Hoen B, Leroy J, Plesiat P, Naber C, Neuerburg C, Mazaheri B, Naber C, Neuerburg C, Thomas T, Giannitsioti E, Mylona E, Paniara O, Papanikolaou K, Pyros J, Skoutelis A, Sharma G, Francis J, Nair L, Thomas V, Venugopal K, Hannan M, Hurley J, Cahan A, Gilon D, Israel S, Korem M, Strahilevitz J, Rubinstein E, Strahilevitz J, Durante-Mangoni E, Mattucci I, Pinto D, Agrusta F, Senese A, Ragone E, Utili R, Cecchi E, De Rosa F, Forno D, Imazio M, Trinchero R, Tebini A, Grossi P, Lattanzio M, Toniolo A, Goglio A, Raglio A, Ravasio V, Rizzi M, Suter F, Carosi G, Magri S, Signorini L, Anouti K, Chahoud J, Kanafani Z, Kanj SS, Abidin I, Tamin SS, Martínez ER, Nieto GI, van der Meer JT, Chambers S, Holland D, Morris A, Raymond N, Read K, Murdoch DR, Dragulescu S, Ionac A, Mornos C, Butkevich O, Chipigina N, Kirill O, Vadim K, Vinogradova T, Edathodu J, Halim M, Liew YY, Tan RS, Lejko-Zupanc T, Logar M, Mueller-Premru M, Commerford P, Commerford A, Deetlefs E, Hansa C, Ntsekhe M, Almela M, Armero Y, Azqueta M, Castañeda X, Cervera C, del Rio A, Falces C, Garcia-de-la-Maria C, Fita G, Gatell JM, Heras M, Llopis J, Marco F, Mestres CA, Miró JM, Moreno A, Ninot S, Paré C, Pericas JM, Ramirez J, Rovira I, Sitges M, Anguera I, Font B, Guma JR, Bermejo J, Bouza E, Fernández MA, Gonzalez-Ramallo V, Marín M, Muñoz P, Pedromingo M, Roda J, Rodríguez-Créixems M, Solis J, Almirante B, Fernandez-Hidalgo N, Tornos P, de Alarcón A, Parra R, Alestig E, Johansson M, Olaison L, Snygg-Martin U, Pachirat O, Pachirat P, Pussadhamma B, Senthong V, Casey A, Elliott T, Lambert P, Watkin R, Eyton C, Klein JL, Bradley S, Kauffman C, Bedimo R, Chu VH, Corey G, Crowley AL, Douglas P, Drew L, Fowler VG, Holland T, Lalani T, Mudrick D, Samad Z, Sexton D, Stryjewski M, Wang A, Woods CW, Lerakis S, Cantey R, Steed L, Wray D, Dickerman SA, Bonilla H, DiPersio J, Salstrom SJ, Baddley J, Patel M, Peterson G, Stancoven A, Levine D, Riddle J, Rybak M, Cabell CH, Baloch K, Chu VH, Corey G, Dixon CC, Fowler VG Jr, Harding T, Jones-Richmond M, Pappas P, Park LP, Sanderford B, Stafford J, Anstrom K, Athan E, Bayer AS, Cabell CH, Chu VH, Corey G, Fowler VG Jr, Hoen B, Karchmer A, Miró JM, Murdoch DR, Sexton DJ, Wang A, Bayer AS, Cabell CH, Chu V, Corey G, Durack DT, Eykyn S, Fowler VG Jr, Hoen B, Miró JM, Moreillon P, Olaison L, Raoult D, Rubinstein E, Sexton DJ.

Author information

  • 1Infectious Disease Clinical Research Program, Bethesda, Maryland.

Erratum in

  • JAMA Intern Med. 2013 Oct 28;173(19):1846.

Abstract

IMPORTANCE:

There are limited prospective, controlled data evaluating survival in patients receiving early surgery vs medical therapy for prosthetic valve endocarditis (PVE).

OBJECTIVE:

To determine the in-hospital and 1-year mortality in patients with PVE who undergo valve replacement during index hospitalization compared with patients who receive medical therapy alone, after controlling for survival and treatment selection bias.

DESIGN, SETTING, AND PARTICIPANTS:

Participants were enrolled between June 2000 and December 2006 in the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS), a prospective, multinational, observational cohort of patients with infective endocarditis. Patients hospitalized with definite right- or left-sided PVE were included in the analysis. We evaluated the effect of treatment assignment on mortality, after adjusting for biases using a Cox proportional hazards model that included inverse probability of treatment weighting and surgery as a time-dependent covariate. The cohort was stratified by probability (propensity) for surgery, and outcomes were compared between the treatment groups within each stratum.

INTERVENTIONS:

Valve replacement during index hospitalization (early surgery) vs medical therapy.

MAIN OUTCOMES AND MEASURES:

In-hospital and 1-year mortality.

RESULTS:

Of the 1025 patients with PVE, 490 patients (47.8%) underwent early surgery and 535 individuals (52.2%) received medical therapy alone. Compared with medical therapy, early surgery was associated with lower in-hospital mortality in the unadjusted analysis and after controlling for treatment selection bias (in-hospital mortality: hazard ratio [HR], 0.44 [95% CI, 0.38-0.52] and lower 1-year mortality: HR, 0.57 [95% CI, 0.49-0.67]). The lower mortality associated with surgery did not persist after adjustment for survivor bias (in-hospital mortality: HR, 0.90 [95% CI, 0.76-1.07] and 1-year mortality: HR, 1.04 [95% CI, 0.89-1.23]). Subgroup analysis indicated a lower in-hospital mortality with early surgery in the highest surgical propensity quintile (21.2% vs 37.5%; P = .03). At 1-year follow-up, the reduced mortality with surgery was observed in the fourth (24.8% vs 42.9%; P = .007) and fifth (27.9% vs 50.0%; P = .007) quintiles of surgical propensity.

CONCLUSIONS AND RELEVANCE:

Prosthetic valve endocarditis remains associated with a high 1-year mortality rate. After adjustment for differences in clinical characteristics and survival bias, early valve replacement was not associated with lower mortality compared with medical therapy in the overall cohort. Further studies are needed to define the effect and timing of surgery in patients with PVE who have indications for surgery.

Comment in

PMID:
23857547
[PubMed - indexed for MEDLINE]
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