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Infective Endocarditis: has its prognosis changed 5 years after the new ESC guidelines?
Session:
Posters (Sessão 5 - Écran 8) - Doença Valvular 4 - Foco na Endocardite
Speaker:
Catarina Ribeiro Carvalho
Congress:
CPC 2022
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
16. Infective Endocarditis
Subtheme:
16.2 Infective Endocarditis – Epidemiology, Prognosis, Outcome
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Catarina Ribeiro Carvalho; José João Monteiro; Pedro Rocha Carvalho; Marta Bernardo; Ana Baptista; José Ilídio Moreira
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> in 2015, new European Society of Cardiology (ESC) guidelines for the management of infective endocarditis (IE) were published, mainly updating antibiotic and surgical recommendations for these patients.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose:</strong> to analyse the impact of the implementation of 2015 ESC guidelines on clinical outcomes of IE patients.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> retrospective study including all IE patients hospitalized in a single centre, between January 2000 and December 2020. Patients were categorized into two groups based on admission date: before (group A) and after 2015 (group B). Baseline and clinical characteristics, and outcomes were compared between the two groups.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> A total of 161 patients were selected, 65.8% were males, with a mean age of 69.0±16.4 years. After 2015, 65 patients (40.4%) were hospitalized. There were no significant differences between groups concerning age or comorbidities.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Regarding major diagnostic criteria, group B had less positive blood cultures (35.2% vs. 64.8%, p=0.018). Prosthetic valve IE was more frequent (65.4% vs. 34.6%, p=0.005), with less native valve involvement (35.1% vs. 64.9%, p=0.044). There was a greater proportion of aortic valve involvement (50.7% vs. 49.3%, p=0.024). After 2015, a reduction on Streptococcus IE was observed (13.8% vs. 37.5%, p=0.001), as well as a trend to more frequent Staphylococcus (33.8% vs. 25.0%) and Enterococcus IE (12.3% vs. 5.2%).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Perivalvular complications were more commonly diagnosed after 2015 (67.6% vs. 32.4%, p=0.002), namely intracardiac fistulae (66.7% vs. 33.3%, p=0.037) and pseudoaneurysms (71.4% vs. 28.6%, p=0.042). There were no significant differences regarding embolic complications, acute heart failure or septic shock during hospitalization. Also, average hospitalization length remained similar (45.8±22.4 vs. 43.7±23.1 days).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Antibiotic choices didn’t significantly differ, however duration of therapy was longer after 2015 [34.0 (IQR 27.5-46.0) vs. 30.0 (IQR 21.0-42.0) days, p=0.043]. The proportion of patients with urgent surgical indication and the surgical timing remained similar [group A: 22.0 (IQR 14.0-55.0) vs. group B: 24.0 (IQR 14.0-38.0) days]. The median follow-up duration was 20.0 (IQR 3.0-46.5) months.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In a multivariate regression analysis, after adjusting for all the possible confounders, there were no significant differences between groups regarding in-hospital mortality (HR = 1.65, 95%CI 0.72-3.75), all-cause mortality during follow-up (HR = 0.87, 95%CI 0.51-1.50) or infective endocarditis recurrence (HR = 0.86, 95%CI 0.27-2.80). </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong> this study suggests that, albeit a tendency to potentially more severe causative agents and more frequent diagnosis of perivalvular complications, there was no significant improvement of in-hospital mortality, all-cause mortality during follow-up or endocarditis recurrence 5 years after the publication of ESC guidelines. </span></span></p>
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