Poor long-term outcomes of intravenous drug users with infectious endocarditisCentral MessagePerspective
Objectives: The optimal management of active endocarditis in intravenous (IV) drug users is still lacking. Methods: From the years 1997 to 2017, 536 patients with active infectious endocarditis were surgically treated, including 83 (15%) with IV drug use (IVDU) and 453 (85%) without IV drug use (non...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-09-01
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| Series: | JTCVS Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S266627362200239X |
| _version_ | 1811209057722171392 |
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| author | Juan Caceres, MD Aroosa Malik, MD Tom Ren, BS Aroma Naeem, BA Jeffrey Clemence, BS Alexander Makkinejad, BS Xiaoting Wu, PhD Bo Yang, MD, PhD |
| author_facet | Juan Caceres, MD Aroosa Malik, MD Tom Ren, BS Aroma Naeem, BA Jeffrey Clemence, BS Alexander Makkinejad, BS Xiaoting Wu, PhD Bo Yang, MD, PhD |
| author_sort | Juan Caceres, MD |
| collection | DOAJ |
| description | Objectives: The optimal management of active endocarditis in intravenous (IV) drug users is still lacking. Methods: From the years 1997 to 2017, 536 patients with active infectious endocarditis were surgically treated, including 83 (15%) with IV drug use (IVDU) and 453 (85%) without IV drug use (non-IVDU). Initial data were obtained from the Society of Thoracic Surgeons database and supplemented with chart review and national death index data. Results: The IVDU group was significantly younger (43 vs 56 years old) than the non-IVDU group and had greater rates of psychiatric disorders, drug use, and tricuspid valve endocarditis (28% vs 8.6%). Hypertension, dyslipidemia, and diabetes mellitus were significantly more common in the non-IVDU group. Perioperative complications and operative mortality (7.2% vs 7.9%) were similar. IVDU was not a significant risk factor for operative mortality. Kaplan–Meier survival was significantly lower in the IVDU group (5-year survival, 46% vs 67%). Significant risk factors for long-time mortality included IV drug use (hazard ratio [HR], 1.92), age ≥65 years (HR, 1.78), congestive heart failure (HR, 1.87), and enterococcus endocarditis (HR, 1.54). The 5-year rate of reoperation was similar between IVDU and non-IVDU groups (2.4% vs 2.7%). Conclusions: IVDU is a significant risk factor for long-term mortality. A multidisciplinary approach was preferred for IVDU patients to treat both endocarditis and substance use disorder and improve long-term survival. |
| first_indexed | 2024-04-12T04:31:50Z |
| format | Article |
| id | doaj.art-e369cb0ce32044fea6616a66419af816 |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-04-12T04:31:50Z |
| publishDate | 2022-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-e369cb0ce32044fea6616a66419af8162022-12-22T03:47:55ZengElsevierJTCVS Open2666-27362022-09-011192104Poor long-term outcomes of intravenous drug users with infectious endocarditisCentral MessagePerspectiveJuan Caceres, MD0Aroosa Malik, MD1Tom Ren, BS2Aroma Naeem, BA3Jeffrey Clemence, BS4Alexander Makkinejad, BS5Xiaoting Wu, PhD6Bo Yang, MD, PhD7University of Michigan Medical School, Ann Arbor, MichUniversity of Michigan Medical School, Ann Arbor, MichDepartment of Cardiac Surgery, Michigan Medicine, Ann Arbor, MichDepartment of Cardiac Surgery, Michigan Medicine, Ann Arbor, MichDepartment of Cardiac Surgery, Michigan Medicine, Ann Arbor, MichDepartment of Cardiac Surgery, Michigan Medicine, Ann Arbor, MichDepartment of Cardiac Surgery, Michigan Medicine, Ann Arbor, MichDepartment of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich; Address for reprints: Bo Yang, MD, PhD, 1500 East Medical Center Dr, 5155 Frankel Cardiovascular Center, Ann Arbor, MI 48109.Objectives: The optimal management of active endocarditis in intravenous (IV) drug users is still lacking. Methods: From the years 1997 to 2017, 536 patients with active infectious endocarditis were surgically treated, including 83 (15%) with IV drug use (IVDU) and 453 (85%) without IV drug use (non-IVDU). Initial data were obtained from the Society of Thoracic Surgeons database and supplemented with chart review and national death index data. Results: The IVDU group was significantly younger (43 vs 56 years old) than the non-IVDU group and had greater rates of psychiatric disorders, drug use, and tricuspid valve endocarditis (28% vs 8.6%). Hypertension, dyslipidemia, and diabetes mellitus were significantly more common in the non-IVDU group. Perioperative complications and operative mortality (7.2% vs 7.9%) were similar. IVDU was not a significant risk factor for operative mortality. Kaplan–Meier survival was significantly lower in the IVDU group (5-year survival, 46% vs 67%). Significant risk factors for long-time mortality included IV drug use (hazard ratio [HR], 1.92), age ≥65 years (HR, 1.78), congestive heart failure (HR, 1.87), and enterococcus endocarditis (HR, 1.54). The 5-year rate of reoperation was similar between IVDU and non-IVDU groups (2.4% vs 2.7%). Conclusions: IVDU is a significant risk factor for long-term mortality. A multidisciplinary approach was preferred for IVDU patients to treat both endocarditis and substance use disorder and improve long-term survival.http://www.sciencedirect.com/science/article/pii/S266627362200239Xcardiac surgeryendocarditisoutcomesaortic valve surgerytricuspid valve surgery |
| spellingShingle | Juan Caceres, MD Aroosa Malik, MD Tom Ren, BS Aroma Naeem, BA Jeffrey Clemence, BS Alexander Makkinejad, BS Xiaoting Wu, PhD Bo Yang, MD, PhD Poor long-term outcomes of intravenous drug users with infectious endocarditisCentral MessagePerspective JTCVS Open cardiac surgery endocarditis outcomes aortic valve surgery tricuspid valve surgery |
| title | Poor long-term outcomes of intravenous drug users with infectious endocarditisCentral MessagePerspective |
| title_full | Poor long-term outcomes of intravenous drug users with infectious endocarditisCentral MessagePerspective |
| title_fullStr | Poor long-term outcomes of intravenous drug users with infectious endocarditisCentral MessagePerspective |
| title_full_unstemmed | Poor long-term outcomes of intravenous drug users with infectious endocarditisCentral MessagePerspective |
| title_short | Poor long-term outcomes of intravenous drug users with infectious endocarditisCentral MessagePerspective |
| title_sort | poor long term outcomes of intravenous drug users with infectious endocarditiscentral messageperspective |
| topic | cardiac surgery endocarditis outcomes aortic valve surgery tricuspid valve surgery |
| url | http://www.sciencedirect.com/science/article/pii/S266627362200239X |
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