Early Surgery in Patients with Infective Endocarditis: A Propensity Score Analysis
Why the study?
Does surgical and medical treatment reduce long-term mortality in patients with left-sided infective endocarditis compared to medical treatment only?
Population
426 patients with infective endocarditis, analyzed using 51 propensity-matched pairs
Comparison
Surgical and medical treatment vs Medical treatment only
Design
Cohort
Authors
Discussion
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Member takes
Implication
Supports mortality benefit of surgery in left-sided IE; hypothesis-generating and requires randomized confirmation.
Key Points
- To determine the impact of surgical therapy on long-term survival in patients with left-sided infective endocarditis after controlling for treatment selection bias.
- Prospectively collected data from 426 patients with infective endocarditis who had left-sided valvular infections without intracardiac devices.
- Used multivariable analysis to identify clinical predictors of surgery and calculated propensity scores for each patient.
- Matched 51 patients who received combined medical and surgical therapy with 51 patients who received medical therapy alone based on their propensity scores.
- Surgical intervention was independently associated with a significant reduction in long-term mortality in the matched cohort (hazard ratio, 0.27; 95% confidence interval, 0.13–0.55).
- Independent risk factors for increased mortality included a history of diabetes mellitus (hazard ratio, 4.81; 95% confidence interval, 2.41–9.62), presence of chronic intravenous catheters at onset (hazard ratio, 2.65; 95% confidence interval, 1.31–5.33), and paravalvular complications (hazard ratio, 2.16; 95% confidence interval, 1.06–4.44).
Structured PICO
Does surgical and medical treatment reduce long-term mortality in patients with left-sided infective endocarditis compared to medical treatment only?
P
Population
426 patients with infective endocarditis (specifically left-side-associated valvular infections without intracardiac devices), analyzed using 51 propensity-matched pairs
I
Intervention
Surgical and medical treatment
C
Comparator
Medical treatment only
O
Outcome
Long-term mortalityhard clinical
In patients with left-sided infective endocarditis, early surgical intervention combined with medical therapy is associated with a significant reduction in long-term mortality compared to medical therapy alone.
Cite This Study
Aksoy et al. (2007) studied this question.