Predictors of embolism and death in left-sided infective endocarditis: the European Society of Cardiology EURObservational Research Programme European Infective Endocarditis registry
Antonia Sambola, Jordi Lozano-Torres, Eric Boersma, Carmen Olmos, Julien Ternacle, Francisco Calvo, Christophe Tribouilloy, Vlatka Rešković Lukšić, Jadranka Šeparović Hanževački, Seung Woo Park, Sebastiaan C.A.M. Bekkers, Kwan‐Leung Chan, Abdallah Almaghraby, Bernard Iung, Patrizio Lancellotti, Gilbert Habib, the ESC EORP EURO-ENDO Registry Investigator Group, Roberto Ferrari, A Alonso, J. J. Bax, Carina Blomström‐Lundqvist, S. Gielen, A P Maggioni, Patrizio Lancellotti, N Maniadakis, Fausto J. Pinto, Frank Ruschitzka, L Tavazzi, P Vardas, F Weidinger, U Zeymer, Alec Vahanian, Andrzej Budaj, Nikolaos Dagres, Nicolas Danchin, Victoria Delgado, Jonathan Emberson, Örjan Friberg, Chris P Gale, Gr. Heyndrickx, B Iung, Sherman A. James, A P Kappetein, A P Maggioni, N Maniadakis, Kristóf Nagy, G Parati, A-S Petronio, Mikko Pietilä, E Prescott, Frank Ruschitzka, Frans Van de Werf, F Weidinger, U Zeymer, Gilbert Habib, Patrizio Lancellotti, Bernard Cosyns, Erwan Donal, Paola Anna Erba, Gilbert Habib, Bernard Iung, Aldo P. Maggioni, Bogdan A. Popescu, Bernard Prendergast, Pilar Tornos, Nora Nabila Ali Tatar-Chentir, Mouaz H. Al‐Mallah, Meriam Åström Aneq, George Athanassopoulos, Luigi P. Badano, S. Benyoussef, Erick Calderón-Aranda, Nuno Cardim, Kwan‐Leung Chan, Bernard Cosyns, Ines Cruz, Thor Edvardsen, Georg Goliasch, Gilbert Habib, Andreas Hagendorff, Krasimira Hristová, Bernard Iung, Otto Kamp, Duk‐Hyun Kang, William Kong, С.Т. Мацкеплишвили, Marwa Meshaal, M Mirocevic, Aleksandar Nešković, Michal Pazderník, Edyta Płońska‐Gościniak, Bogdan A. Popescu, Bernard Prendergast, Maha Raissouni, Ricardo Ronderos, Leyla Elif Sade, Anita Sadeghpour, Antonia Sambola, Shantanu P. Sengupta, Jadranka Šeparović Hanževački
Abstract
BACKGROUND AND AIMS: Even though vegetation size in infective endocarditis (IE) has been associated with embolic events (EEs) and mortality risk, it is unclear whether vegetation size associated with these potential outcomes is different in left-sided IE (LSIE). This study aimed to seek assessing the vegetation cut-off size as predictor of EE or 30-day mortality for LSIE and to determine risk predictors of these outcomes. METHODS: The European Society of Cardiology EURObservational Research Programme European Infective Endocarditis is a prospective, multicentre registry including patients with definite or possible IE throughout 2016-18. Cox multivariable logistic regression analysis was performed to assess variables associated with EE or 30-day mortality. RESULTS: There were 2171 patients with LSIE (women 31.5%). Among these affected patients, 459 (21.1%) had a new EE or died in 30 days. The cut-off value of vegetation size for predicting EEs or 30-day mortality was >10 mm [hazard ratio (HR) 1.38, 95% confidence interval (CI) 1.13-1.69, P = .0015]. Other adjusted predictors of risk of EE or death were as follows: EE on admission (HR 1.89, 95% CI 1.54-2.33, P < .0001), history of heart failure (HR 1.53, 95% CI 1.21-1.93, P = .0004), creatinine >2 mg/dL (HR 1.59, 95% CI 1.25-2.03, P = .0002), Staphylococcus aureus (HR 1.36, 95% CI 1.08-1.70, P = .008), congestive heart failure (HR 1.40, 95% CI 1.12-1.75, P = .003), presence of haemorrhagic stroke (HR 4.57, 95% CI 3.08-6.79, P < .0001), alcohol abuse (HR 1.45, 95% CI 1.04-2.03, P = .03), presence of cardiogenic shock (HR 2.07, 95% CI 1.29-3.34, P = .003), and not performing left surgery (HR 1.30 95% CI 1.05-1.61, P = .016) (C-statistic = .68). CONCLUSIONS: Prognosis after LSIE is determined by multiple factors, including vegetation size.