The association between vegetation size and surgical treatment on 6-month mortality in left-sided infective endocarditis

Emil L Fosbøl, Lawrence P Park, Vivian H Chu, Eugene Athan, Francois Delahaye, Tomas Freiberger, Cristiane Lamas, Jose M Miro, Jacob Strahilevitz, Christophe Tribouilloy, Emanuele Durante-Mangoni, Juan M Pericas, Nuria Fernández-Hidalgo, Francisco Nacinovich, Hussein Rizk, Bruno Barsic, Efthymia Giannitsioti, John P Hurley, Margaret M Hannan, Andrew WangICE-PLUS Investigators


AIMS: In left-sided infective endocarditis (IE), a large vegetation >10 mm is associated with higher mortality, yet it is unknown whether surgery during the acute phase opposed to medical therapy is associated with improved survival. We assessed the association between surgery and 6-month mortality as related to vegetation size.

METHODS AND RESULTS: Patients with definite, left-sided IE (2008-2012) from The International Collaboration on Endocarditis prospective, multinational registry were included. We compared clinical characteristics and 6-month mortality (by Cox regression with inverse propensity of treatment weighting) between patients with vegetation size ≤10 mm vs. >10 mm in maximum length by surgical treatment strategy. A total of 1006 patients with left sided IE were included; 422 with a vegetation size ≤10 mm (median age 66.0 years, 33% women) and 584 (median age 58.4 years, 34% women) patients with a large vegetation >10 mm. Operative risk by STS-IE score was similar between groups. Embolic events occurred in 28.4% vs. 44.3% (P < 0.001), respectively. Patients with a vegetation >10 mm was associated with higher 6-month mortality (25.1% vs. 19.4% for small vegetation, P = 0.035). However, after propensity adjustment, the association with higher mortality persisted only in patients with a large vegetation >10 mm vs. ≤10 mm: hazard ratio (HR) 1.55 (1.27-1.90); but only in patients with large vegetation managed medically [HR 1.86 (1.48-2.34)] rather than surgically [HR 1.01 (0.69-1.49)].

CONCLUSION: Left-sided IE with vegetation size >10 mm was associated with an increased mortality at 6 months in this observational study but was dependent on treatment strategy. For patients with large vegetation undergoing surgical treatment, survival was similar to patients with smaller vegetation size.

TidsskriftEuropean Heart Journal
Udgave nummer27
Sider (fra-til)2243-2251
Antal sider9
StatusUdgivet - 14 jul. 2019


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