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Infective endocarditis: determinants of long term outcome
R O M Netzer1, S C Altwegg, E Zollinger
1Swiss Cardiovascular Centre Bern, University Hospital, Bern, Switzerland Institute for Infectious Diseases, University Hospital, Bern, Switzerland.
Objective:
To evaluate predictors of long term prognosis in infective endocarditis.
Design:
Retrospective cohort study.
Setting:
Tertiary care centre.
Patients:
212 consecutive patients with infective endocarditis between 1980 and 1995
Main Outcome Measures:
Overall and cardiac mortality; event-free survival; and the following events: recurrence, need for late valve surgery, bleeding and embolic complications, cerebral dysfunction, congestive heart failure.
Results:
During a mean follow up period of 89 months (range 1-244 months), 56% of patients died. In 180 hospital survivors, overall and cardiac mortality amounted to 45% and 24%, respectively. By multivariate analysis, early surgical treatment, infection by streptococci, age < 55 years, absence of congestive heart failure, and > 6 symptoms or signs of endocarditis during active infection were predictive of improved overall long term survival. Independent determinants of event-free survival were infection by streptococci and age < 55 years. Event-free survival was 17% at the end of follow up both in medically-surgically treated patients and in medically treated patients.
Conclusions:
Long term survival following infective endocarditis is 50% after 10 years and is predicted by early surgical treatment, age < 55 years, lack of congestive heart failure, and the initial presence of more symptoms of endocarditis.