Impact of cerebrovascular complications on mortality and neurologic outcome during infective endocarditis: a prospective multicentre study

AIMS: To analyse the risk of death according to the type of cerebrovascular complications (CVC) during infective endocarditis (IE) and to analyse the determinants of outcome in patients with IE and a CVC. METHODS AND RESULTS: In two referral centres, 496 consecutive patients with definite IE were prospectively included. Cerebral CT scan was performed in 453 patients. During a mean 2.9 year follow-up, 139 (28%) patients died and CVC occurred in 109 (22%) patients. Stroke was an independent predictor of death, although no significant excess mortality was observed in patients with silent CVC or transient ischaemic attack (TIA). Among CVC patients, mortality was predicted by the presence of a mechanical prosthetic valve IE and a low Glasgow Coma Scale. When valvular surgery was performed in patients after CVC, neurologic exacerbation was rare 4 (6.3%) patients and was observed only in patients with symptomatic stroke. Among CVC patients, survival was better in operated patients when compared with patients treated conservatively despite theoretical indication for surgery (P < 0.0001). However, the latter group had more comorbidities (P = 0.007) and a lower Glasgow Coma Scale (14.6 +/- 1 vs. 12 +/- 4, P < 0.0001). CONCLUSION: Patients with silent CVC or TIA have a relatively good prognosis, whereas those with stroke have significant excess mortality particularly in case of mechanical prosthetic valve IE or impaired consciousness. Valvular surgery can be safely performed after silent CVC or TIA and may improve survival in selected patients with stroke.