TY - JOUR
T1 - Patient characteristics, valve surgery and 1-year mortality in left-sided Staphylococcus aureus infective endocarditis
T2 - a nationwide study
AU - Nielsen, Sikander Tajik
AU - Graversen, Peter Laursen
AU - Hadji-Turdeghal, Katra
AU - Moller, Jacob Eifer
AU - Bruun, Niels Eske
AU - Jensen, Andreas Dalsgaard
AU - Petersen, Jeppe K
AU - Povlsen, Jonas Agerlund
AU - Moser, Claus
AU - Smerup, Morten
AU - Jensen, Hanne Sortsøe
AU - Faurholt-Jepsen, Daniel
AU - Søgaard, Peter
AU - Helweg-Larsen, Jannik
AU - Bundgaard, Henning
AU - Iversen, Kasper
AU - Østergaard, Lauge
AU - Køber, Lars
AU - Fosbøl, Emil Loldrup
N1 - © Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.
PY - 2025/11/20
Y1 - 2025/11/20
N2 - BACKGROUND: Staphylococcus aureus infective endocarditis (SA-IE) remains a serious condition, with in-hospital mortality rates ranging between 30% and 40%. While current guidelines suggest surgery may be considered in all SA-IE cases, robust data comparing outcomes between patients undergoing surgery and those receiving medical therapy alone are scarce.METHODS: Using the NatIonal Danish endocarditis stUdieS registry, we identified all patients with left-sided SA-IE between 2016 and 2021. Patients were categorised into two groups: surgical and non-surgical. Baseline characteristics were assessed, and in-hospital mortality was analysed using crude estimates and multivariable Cox regression.RESULTS: Of 918 patients identified, 160 (17%) patients underwent surgery (median age 63.7 years; 73% male), and 758 (83%) were treated non-surgically (median age 75.0 years; 58% male). Surgical patients had fewer comorbidities, including diabetes (18% vs 27%) and congestive heart failure (6% vs 19%). Surgical patients presented at admission with more severe conditions, including larger vegetations (56% vs 21%), sepsis (53% vs 33%) and emboli (24% vs 10%). Crude in-hospital mortality was lower in the surgical group (17% vs 28%), as was 1 year mortality (21% vs 45%). After adjusting for confounders, there was no significant difference in adjusted in-hospital mortality between the groups (HR 0.75 (95% CI 0.47 to 1.19)); however, 1-year mortality was statistically significantly lower in surgical patients (HR 0.61 (95% CI 0.41 to 0.91)).CONCLUSION: In patients with SA-IE, surgical patients were younger and had fewer comorbidities, but had more severe disease status at admission, compared with non-surgical patients. Surgery was associated with lower 1-year mortality, but the heterogeneity of this patient population limits firm conclusions about the superiority of either treatment strategy.
AB - BACKGROUND: Staphylococcus aureus infective endocarditis (SA-IE) remains a serious condition, with in-hospital mortality rates ranging between 30% and 40%. While current guidelines suggest surgery may be considered in all SA-IE cases, robust data comparing outcomes between patients undergoing surgery and those receiving medical therapy alone are scarce.METHODS: Using the NatIonal Danish endocarditis stUdieS registry, we identified all patients with left-sided SA-IE between 2016 and 2021. Patients were categorised into two groups: surgical and non-surgical. Baseline characteristics were assessed, and in-hospital mortality was analysed using crude estimates and multivariable Cox regression.RESULTS: Of 918 patients identified, 160 (17%) patients underwent surgery (median age 63.7 years; 73% male), and 758 (83%) were treated non-surgically (median age 75.0 years; 58% male). Surgical patients had fewer comorbidities, including diabetes (18% vs 27%) and congestive heart failure (6% vs 19%). Surgical patients presented at admission with more severe conditions, including larger vegetations (56% vs 21%), sepsis (53% vs 33%) and emboli (24% vs 10%). Crude in-hospital mortality was lower in the surgical group (17% vs 28%), as was 1 year mortality (21% vs 45%). After adjusting for confounders, there was no significant difference in adjusted in-hospital mortality between the groups (HR 0.75 (95% CI 0.47 to 1.19)); however, 1-year mortality was statistically significantly lower in surgical patients (HR 0.61 (95% CI 0.41 to 0.91)).CONCLUSION: In patients with SA-IE, surgical patients were younger and had fewer comorbidities, but had more severe disease status at admission, compared with non-surgical patients. Surgery was associated with lower 1-year mortality, but the heterogeneity of this patient population limits firm conclusions about the superiority of either treatment strategy.
UR - https://www.scopus.com/pages/publications/105022709084
U2 - 10.1136/heartjnl-2025-327031
DO - 10.1136/heartjnl-2025-327031
M3 - Journal article
C2 - 41266240
SN - 1355-6037
JO - Heart (British Cardiac Society)
JF - Heart (British Cardiac Society)
M1 - heartjnl-2025-327031
ER -