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Temporal relationship between infective endocarditis and stroke
Alexander E Merkler1, Stacy Y Chu2, Michael P Lerario2
1From the Department of Neurology (A.E.M., M.P.L., B.B.N., H.K.) and Feil Family Brain and Mind Research Institute (B.B.N., H.K.), Weill Cornell Medical College, New York, NY; and Department of Neurology (S.Y.C.), Yale School of Medicine, New Haven, CT. alm9097@nyp.org.
Insights
Stroke risk significantly increases around infective endocarditis (IE) diagnosis, starting months before and continuing afterward. This heightened risk period for stroke associated with IE is longer than previously understood.
Area of Science:
- Cardiology
- Neurology
- Infectious Diseases
Background:
- Stroke is a common complication of infective endocarditis (IE).
- The precise timing of stroke risk relative to IE diagnosis remains unclear.
Purpose of the Study:
- To investigate the temporal relationship between infective endocarditis and stroke.
- To quantify stroke risk in the months preceding and following IE diagnosis.
Main Methods:
- Retrospective analysis of adult patients hospitalized with IE.
- Utilized diagnosis codes to identify strokes (ischemic/hemorrhagic) within a 12-month window around IE diagnosis.
- Compared stroke odds during specific periods to a baseline risk from 2 years prior.
Main Results:
- A significant increase in stroke risk was observed starting 4 months before IE diagnosis and lasting 5 months after.
- The highest stroke risk occurred in the month immediately following IE diagnosis, with an odds ratio of 96.5.
- This represents an absolute risk increase of 9.1% in the month post-IE diagnosis.
Conclusions:
- The association between IE and stroke extends beyond the immediate diagnosis period.
- Heightened stroke risk is evident months before and after IE diagnosis, indicating a prolonged vulnerable period.
- Findings suggest a need for closer monitoring for stroke in patients with IE, even before and long after diagnosis.
Objective:
Stroke frequently complicates infective endocarditis (IE). However, the temporal relationship between these diseases is uncertain.
Methods:
We performed a retrospective study of adult patients hospitalized for IE between July 1, 2007, and June 30, 2011, at nonfederal acute care hospitals in California. Previously validated diagnosis codes were used to identify the primary composite outcome of ischemic or hemorrhagic stroke during discrete 1-month periods from 6 months before to 6 months after the diagnosis of IE. The odds of stroke in these periods were compared with the odds of stroke in the corresponding 1-month period 2 years earlier, which was considered the baseline risk of stroke.
Results:
Among 17,926 patients with IE, 2,275 strokes occurred within the 12-month period surrounding the diagnosis of IE. The risk of stroke was highest in the month after diagnosis of IE (1,640 vs 17 strokes in the corresponding month 2 years prior). This equaled an absolute risk increase of 9.1% (95% confidence interval 8.6%-9.5%) and an odds ratio of 96.5 (95% confidence interval 60.1-166.0). Stroke risk was significantly increased beginning 4 months before the diagnosis of IE and lasting 5 months afterward. Similar temporal patterns were seen when ischemic and hemorrhagic strokes were considered separately.
Conclusions:
The association between IE and stroke persists for longer than previously reported. Most diagnoses of stroke and IE are made close together in time, but a period of heightened stroke risk becomes apparent several months before the diagnosis of IE and lasts for several months afterward.
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