Conservative Versus Surgical Therapy in Patients With Infective Endocarditis and Surgical Indication—Meta‐Analysis of Reconstructed Time‐to‐Event Data
Background Infective endocarditis represents a life‐threatening disease with high mortality rates. A fraction of patients receives exclusively conservative antibiotic treatment due to their comorbidities and high operative risk, despite fulfilling criteria for surgical therapy. The aim of the presen...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.033404 |
| _version_ | 1797229246743052288 |
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| author | Tulio Caldonazo Stefan Hagel Torsten Doenst Hristo Kirov Michel Pompeu Sá Xander Jacquemyn Panagiotis Tasoudis Marcus Franz Mahmoud Diab |
| author_facet | Tulio Caldonazo Stefan Hagel Torsten Doenst Hristo Kirov Michel Pompeu Sá Xander Jacquemyn Panagiotis Tasoudis Marcus Franz Mahmoud Diab |
| author_sort | Tulio Caldonazo |
| collection | DOAJ |
| description | Background Infective endocarditis represents a life‐threatening disease with high mortality rates. A fraction of patients receives exclusively conservative antibiotic treatment due to their comorbidities and high operative risk, despite fulfilling criteria for surgical therapy. The aim of the present study is to compare outcomes in patients with infective endocarditis and indication for surgical therapy in those who underwent or did not undergo valve surgery. Methods and Results Three databases were systematically assessed. A pooled analysis of Kaplan–Meier–derived reconstructed time‐to‐event data from studies with longer follow‐up comparing conservative and surgical treatment was performed. A landmark analysis to further elucidate the effect of surgical intervention on mortality was carried out. Four studies with 3003 patients and median follow‐up time of 7.6 months were included. Overall, patients with an indication for surgery who were surgically treated had a significantly lower risk of mortality compared with patients who received conservative treatment (hazard ratio [HR], 0.27 [95% CI, 0.24–0.31], P<0.001). The survival analysis in the first year showed superior survival for patients who underwent surgery when compared with those who did not at 1 month (87.6% versus 57.6%; HR, 0.31 [95% CI, 0.26–0.37], P<0.01), at 6 months (74.7% versus 34.6%) and at 12 months (73.3% versus 32.7%). Conclusions Based on the findings of this study‐level meta‐analysis, patients with infective endocarditis and formal indication for surgical intervention who underwent surgery are associated with a lower risk of short‐ and long‐term mortality when compared with conservative treatment. |
| first_indexed | 2024-04-24T15:09:33Z |
| format | Article |
| id | doaj.art-6356aeff051146c18f6aa951e2e1c8d0 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-24T15:09:33Z |
| publishDate | 2024-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-6356aeff051146c18f6aa951e2e1c8d02024-04-02T11:49:51ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-04-0113710.1161/JAHA.123.033404Conservative Versus Surgical Therapy in Patients With Infective Endocarditis and Surgical Indication—Meta‐Analysis of Reconstructed Time‐to‐Event DataTulio Caldonazo0Stefan Hagel1Torsten Doenst2Hristo Kirov3Michel Pompeu Sá4Xander Jacquemyn5Panagiotis Tasoudis6Marcus Franz7Mahmoud Diab8Department of Cardiothoracic Surgery Friedrich‐Schiller‐University Jena Jena GermanyInstitute for Infectious Diseases and Infection Control, Friedrich‐Schiller‐University Jena Jena GermanyDepartment of Cardiothoracic Surgery Friedrich‐Schiller‐University Jena Jena GermanyDepartment of Cardiothoracic Surgery Friedrich‐Schiller‐University Jena Jena GermanyDepartment of Cardiothoracic Surgery University of Pittsburgh Pittsburgh PA USADepartment of Cardiovascular Sciences KU Leuven Leuven BelgiumDivision of Cardiothoracic Surgery University of North Carolina Chapel Hill NC USADivision of Cardiology, Department of Internal Medicine Friedrich‐Schiller‐University Jena Jena GermanyDepartment of Cardiothoracic Surgery Friedrich‐Schiller‐University Jena Jena GermanyBackground Infective endocarditis represents a life‐threatening disease with high mortality rates. A fraction of patients receives exclusively conservative antibiotic treatment due to their comorbidities and high operative risk, despite fulfilling criteria for surgical therapy. The aim of the present study is to compare outcomes in patients with infective endocarditis and indication for surgical therapy in those who underwent or did not undergo valve surgery. Methods and Results Three databases were systematically assessed. A pooled analysis of Kaplan–Meier–derived reconstructed time‐to‐event data from studies with longer follow‐up comparing conservative and surgical treatment was performed. A landmark analysis to further elucidate the effect of surgical intervention on mortality was carried out. Four studies with 3003 patients and median follow‐up time of 7.6 months were included. Overall, patients with an indication for surgery who were surgically treated had a significantly lower risk of mortality compared with patients who received conservative treatment (hazard ratio [HR], 0.27 [95% CI, 0.24–0.31], P<0.001). The survival analysis in the first year showed superior survival for patients who underwent surgery when compared with those who did not at 1 month (87.6% versus 57.6%; HR, 0.31 [95% CI, 0.26–0.37], P<0.01), at 6 months (74.7% versus 34.6%) and at 12 months (73.3% versus 32.7%). Conclusions Based on the findings of this study‐level meta‐analysis, patients with infective endocarditis and formal indication for surgical intervention who underwent surgery are associated with a lower risk of short‐ and long‐term mortality when compared with conservative treatment.https://www.ahajournals.org/doi/10.1161/JAHA.123.033404conservative therapyheart surgeryinfective endocarditis |
| spellingShingle | Tulio Caldonazo Stefan Hagel Torsten Doenst Hristo Kirov Michel Pompeu Sá Xander Jacquemyn Panagiotis Tasoudis Marcus Franz Mahmoud Diab Conservative Versus Surgical Therapy in Patients With Infective Endocarditis and Surgical Indication—Meta‐Analysis of Reconstructed Time‐to‐Event Data Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease conservative therapy heart surgery infective endocarditis |
| title | Conservative Versus Surgical Therapy in Patients With Infective Endocarditis and Surgical Indication—Meta‐Analysis of Reconstructed Time‐to‐Event Data |
| title_full | Conservative Versus Surgical Therapy in Patients With Infective Endocarditis and Surgical Indication—Meta‐Analysis of Reconstructed Time‐to‐Event Data |
| title_fullStr | Conservative Versus Surgical Therapy in Patients With Infective Endocarditis and Surgical Indication—Meta‐Analysis of Reconstructed Time‐to‐Event Data |
| title_full_unstemmed | Conservative Versus Surgical Therapy in Patients With Infective Endocarditis and Surgical Indication—Meta‐Analysis of Reconstructed Time‐to‐Event Data |
| title_short | Conservative Versus Surgical Therapy in Patients With Infective Endocarditis and Surgical Indication—Meta‐Analysis of Reconstructed Time‐to‐Event Data |
| title_sort | conservative versus surgical therapy in patients with infective endocarditis and surgical indication meta analysis of reconstructed time to event data |
| topic | conservative therapy heart surgery infective endocarditis |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.033404 |
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