Early surgery in patients with infective endocarditis: a propensity score analysis

Area of Science:

• Cardiology
• Infectious Diseases
• Surgical Outcomes

Background:

• Retrospective studies of infective endocarditis (IE) are limited by treatment biases, hindering accurate assessment of long-term mortality predictors.
• The role of surgery in long-term survival for IE patients remains inadequately studied due to these limitations.

Purpose of the Study:

• To prospectively evaluate predictors of long-term mortality in infective endocarditis patients.
• To determine the impact of surgical intervention on long-term survival in IE, controlling for confounding factors.

Main Methods:

• Prospective data collection from 426 infective endocarditis patients.
• Multivariable analysis identified variables associated with surgery in left-side valvular infections.
• Propensity score matching was used to compare outcomes between medically and surgically treated patients (51 pairs).

Main Results:

• Surgery was associated with decreased long-term mortality (hazard ratio, 0.27).
• Independent predictors of increased mortality included diabetes mellitus (hazard ratio, 4.81), chronic catheters (hazard ratio, 2.65), and paravalvular complications (hazard ratio, 2.16).
• Factors associated with receiving surgery included age, transfer status, physical exam findings, staphylococcal infection, heart failure, abscess, and hemodialysis.

Conclusions:

• Propensity score methodology effectively controlled for treatment selection bias and prognostic factor imbalances.
• Diabetes mellitus, chronic catheters, and paravalvular complications are independent risk factors for increased long-term mortality in IE.
• Surgical therapy demonstrated a significant long-term survival benefit for patients with infective endocarditis.