What is the clinical evidence from this study?

Study design: Cohort. Population: left-sided infective endocarditis (n=211). Intervention: Previous embolism vs. No previous embolism. Primary outcome: embolic events after the initiation of antibiotic therapy (RR 1.73, 95% CI 1.02-2.93, p=0.05).

September 7, 2026Journal of the American College of CardiologyOpen Access

Risk of embolization after institution of antibiotic therapy for infective endocarditis

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Key result

Prior embolism is linked to ~73% higher risk of new embolic events during antibiotic therapy.

RR 1.73
95% CI 1.02-2.93
P=0.05
n=211

Why the study?

What are the risk factors for systemic embolization after initiation of antibiotic therapy in patients with left-sided infective endocarditis?

Population

211 prospectively recruited patients experiencing 217 episodes of left-sided infective endocarditis.

Design

Cohort

Follow-up

mean 151 days

Authors

IVIsidre VilacostaInterventional / Structural Cardiology CGCatherine GraupnerHospital Universitario de Fuenlabrada JSJoséAlberto SanRománHospital Clínico Universitario de Valladolid

Discussion

Member takes

Implication

Previous embolism and increasing vegetation size despite antimicrobial treatment are significant predictors of subsequent systemic embolization in patients with left-sided infective endocarditis.

Key Points

To assess the risk and determinants of systemic embolization in patients with left-sided infective endocarditis following the initiation of adequate antibiotic therapy.
Prospective cohort study analyzing 217 episodes of left-sided endocarditis in 211 patients (91% definite by Duke criteria; 72 prosthetic valve infections).
All patients underwent both transthoracic and transesophageal echocardiography, with clinical and microbiological data monitored over a mean follow-up of 151 days.
Embolic events occurred in 28 episodes (12.9%) after starting antibiotics, with 52% involving the central nervous system and 65% occurring within the first two weeks.
A history of prior embolism predicted new embolic events (RR 1.73, 95% CI 1.02 to 2.93; p = 0.05), and an increase in vegetation size during follow-up raised embolic risk (RR 2.64, 95% CI 0.98 to 7.16; p = 0.02).
Large vegetations (≥10 mm) significantly increased embolization risk in staphylococcal endocarditis (p = 0.04) and mitral valve infection (p = 0.03), but not in aortic or streptococcal infections.

Study Design

Type

Cohort (n=211)

Structured PICO

What are the risk factors for systemic embolization after initiation of antibiotic therapy in patients with left-sided infective endocarditis?

Population

211 prospectively recruited patients experiencing 217 episodes of left-sided infective endocarditis, followed for a mean of 151 days.

Exposure

Initiation of adequate antibiotic treatment

Outcome

Systemic embolization after initiation of antibiotic therapyhard clinical

Main Result

Relative Risk: 1.73 (95% CI 1.02–2.93)

p-value: p=0.05

Previous embolism and increasing vegetation size despite antimicrobial treatment are significant predictors of subsequent systemic embolization in patients with left-sided infective endocarditis.

Cite This Study

Vilacosta et al. (2002) conducted a cohort in left-sided infective endocarditis (n=211). Previous embolism vs. No previous embolism was evaluated on embolic events after the initiation of antibiotic therapy (RR 1.73, 95% CI 1.02-2.93, p=0.05). Previous embolism was associated with an increased risk of new embolic events after initiation of antibiotic therapy (RR 1.73; 95% CI 1.02-2.93; p=0.05).

synapsesocial.com/papers/6a9ed5dbae051fe680bc566c https://doi.org/10.1016/s0735-1097(02)01790-4

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Implication

Previous embolism and increasing vegetation size despite antimicrobial treatment are significant predictors of subsequent systemic embolization in patients with left-sided infective endocarditis.

Risk of embolization after institution of antibiotic therapy for infective endocarditis

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Risk of embolization after institution of antibiotic therapy for infective endocarditis

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Also Consider