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Long-Term Clinical Outcome of Major Adverse Cardiac Events in Survivors of Infectious Endocarditis: A Nationwide Population-Based Study
Study Questions:
What are the long-term risks of morbidity (stroke, myocardial infarction, heart failure) and death (cardiovascular death, all-cause mortality) among survivors of infective endocarditis (IE)?
Methods:
A nationwide population-based cohort study was conducted among IE survivors during 2000-2009, identified using Taiwan’s National Health Insurance Research Database. IE survivors were defined as those who survived after discharge from first hospitalization with a diagnosis of IE. A total of 10,116 IE survivors were identified, and matched 1:1 to control subjects without IE using propensity scores. The primary outcomes were stroke, myocardial infarction, readmission for heart failure, and sudden cardiac death or ventricular arrhythmia; secondary outcomes were repeat IE and all-cause mortality.
Results:
Compared with the matched cohort, IE survivors had higher rates of ischemic stroke (adjusted hazard ratio [HR], 1.59; 95% confidence interval [CI], 1.40-1.80), hemorrhagic stroke (HR, 2.37; 95% CI, 1.90-2.96), myocardial infarction (HR, 1.44; 95% CI, 1.17-1.79), readmission for heart failure (HR, 2.24; 95% CI, 2.05-2.43), sudden death or ventricular arrhythmia (HR, 1.69; 95% CI, 1.44-1.98), and all-cause death (HR, 2.27; 95% CI, 2.14-2.40). Risk factors for repeat IE were older age, male sex, drug abuser, and valve replacement after the initial episode of IE.
Conclusions:
The authors concluded that despite treatment, the risk of long-term major adverse cardiac events is substantially increased in IE survivors.
Perspective:
Current guidelines recommend the use of antibiotic prophylaxis against IE only among patients with the greatest risk of an adverse outcome from endocarditis––notably excluding patients with native valve disease (bicuspid aortic valve, mitral valve prolapse) who have a high life-time risk of IE, but apparently not a risk of adverse outcome from IE. What part of a 12% (<65 years of age) to 25% (≥65 years of age) in-hospital mortality for left-sided native valve IE (Durante-Mangoni E, et al., Arch Intern Med 2008;168:2095-103) or increased lifetime risk of ischemic and hemorrhagic stroke, myocardial infarction, heart failure, sudden death, or all-cause death (present study) qualify as not being an adverse outcome?
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