engleski

Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke

Background: Stroke occurs in about 20% of patients with IE. In previous studies we showed that cardiac surgery (CS) during acute episode of IE decreases intrahospital mortality in patients complicated with stroke. Outcome related to the timing of surgery was not evaluated. The aim was to assess the influence of the timing of cardiac surgery (CS) on patients’ outcome in patients with IE complicated with stroke. Methods and results: From January 1, 2000 and August 31 2005, 2760 cases of definite IE were included by 61 centers in 28 countries. Each center utilized a standard case report form. Stroke was characterized as ischemic or hemorrhagic using neuroimaging results. Early surgery was defined as CS performed within two weeks from stroke, and late surgery if performed more than two weeks from the date of stroke. This study included only patients with known date of stroke and date of cardiac surgery. The primary outcome was intrahospital mortality. There were 34 patients with hemorrhagic stroke and performed CS and 100 patients with ischemic stroke and performed CS. In the group of patients with hemorrhagic stroke and late CS 3 of 22 patients died vs four of 12 patients in early CS group (p=0.175). In the group of patients with ischemic stroke and late performed CS 4 of 45 patients died vs 13 of 54 in early CS group (p=0.046). Overall, late CS was associated with improved outcome. Intrahospital mortality in late CS was significantly lower than in early CS group (10.4% vs 25.7 ; p=0.038). Chances for survival were almost three times higher if surgery was performed more than two weeks from stroke (OR 2.97, 95%CI 1.05– 8.67). Conclusions: Cardiac surgery during acute episode of IE significantly improves survival in patients complicated with stroke. Late cardiac surgery (more than two weeks after stroke) is associated with better outcome.

IE; stroke; cardiac surgery; outcome

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