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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
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12. Coronary Artery Disease (Chronic)
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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
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28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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A risk prediction score for early-medium term adverse events in patients with infective endocarditis
Session:
Posters 2 - Écran 2 - Doença Valvular
Speaker:
Ana Rita Pereira
Congress:
CPC 2019
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
16. Infective Endocarditis
Subtheme:
16.2 Infective Endocarditis – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Ana Rita F. Pereira; Alexandra Briosa; Dra. Inês Cruz; Ana I. Marques; Sofia Alegria; Dra. Ana Broa; Daniel Sebaiti; Ana Catarina Gomes; Ana Almeida; Helder Pereira
Abstract
<p><strong>Introduction: </strong>Host factors and complications have been associated with higher mortality and morbidity rates in infective endocarditis (IE). In 2016, a validated risk score for predicting 6-month mortality was published, based on 2 prospective multinational registries; not including Portugal as a participating country (<em>J Am Heart Assoc</em>. 2016; 5: e2003016).</p> <p><strong>Objectives: </strong>To identify independent predictors of early-medium term adverse events on a Portuguese population with IE and to develop a score system for risk stratification. To assess the predictive value of the 2016 risk score in that population and compare the accuracy of both models.</p> <p><strong>Methods: </strong>Retrospective study including consecutive patients (pts) admitted to a tertiary center with the diagnosis of IE from 2006 to 2017. Clinical, echocardiographic and follow-up data were evaluated. Early-medium term adverse events were a composite of 6-month mortality (including in-hospital death) and reinfection (≤ 6 months from the initial diagnosis). The proposed score was developed from the entire data set using the Cox proportional hazards model. The 2016 validated score, consisting of 14 variables, was applied to each case. Receiver operating characteristic (ROC) curves and area under curve (AUC) were calculated for both scores and used for comparison.</p> <p><strong>Results: </strong>174 episodes of IE were included in a total of 167 pts (mean age 62.2 ± 16.2 years, 75.3% male). Native valve infection occurred in 73.6%. Aortic valve was the most affected and <em>Staphylococcus aureus</em>the mainly isolated agent. The adverse events occurred in 41.4% of cases: 6-month mortality rate was 40.2% (n = 70, 50 pts died during hospital stay) and reinfection rate 1.2% (n = 2). Multivariate Cox regression identified 4 independent predictors (only 1 protector): paravalvular abscess (HR 2.1, 95%CI 1.1-4.2, p = 0.03); heart failure development (HR 1.9, 95%CI 1.2-3.4, p = 0.01); progression to septic shock (HR 3.6, 95%CI 1.9-6.4, p < 0.01); cardiac surgery (HR 0.6, 95%CI 0.3-0.9, p = 0.04). The AUC was 0.74 (95%CI 0.7-0.8, p < 0.01) for the proposed score which performed similarly to the 2016 validated risk score (AUC 0.67, 95%CI 0.6-0.8, p < 0.01).</p> <p><strong>Conclusions: </strong>In this population, IE was associated with a high rate of early-medium term adverse events. Comparing with the 2016 validated score, the proposed model seemed to have at least similarly accuracy for risk stratification of pts with IE and it included only 4 independent predictors, making it easier to apply.</p>
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