Prediction of Symptomatic Embolism in Infective Endocarditis

Objectives The aim of this study was to develop and validate a simple calculator to quantify the embolic risk (ER) at admission of patients with infective endocarditis. Background Early valve surgery reduces the incidence of embolism in high-risk patients with endocarditis, but the quantification of...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2013-10, Vol.62 (15), p.1384-1392
Main Authors: Hubert, Sandrine, MD, Thuny, Franck, MD, PhD, Resseguier, Noemie, MD, Giorgi, Roch, MD, PhD, Tribouilloy, Christophe, MD, PhD, Le Dolley, Yvan, MD, Casalta, Jean-Paul, MD, Riberi, Alberto, MD, Chevalier, Florent, MD, Rusinaru, Dan, MD, Malaquin, Dorothée, MD, Remadi, Jean Paul, MD, Ammar, Ammar Ben, MD, Avierinos, Jean Francois, MD, Collart, Frederic, MD, Raoult, Didier, MD, PhD, Habib, Gilbert, MD
Format: Article
Language:English
Subjects:
Antibiotics
Anticoagulants
Cardiology
Cardiovascular
Cardiovascular disease
Comorbidity
Confidence intervals
Diabetes
Drug therapy
Drug use
embolism
Embolisms
endocarditis
Heart failure
Internal Medicine
Medical imaging
Multivariate analysis
Older people
prognosis
Surgery
Vegetation
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Summary:Objectives The aim of this study was to develop and validate a simple calculator to quantify the embolic risk (ER) at admission of patients with infective endocarditis. Background Early valve surgery reduces the incidence of embolism in high-risk patients with endocarditis, but the quantification of ER remains challenging. Methods From 1,022 consecutive patients presenting with definite diagnoses of infective endocarditis in a multicenter observational cohort study, 847 were randomized into derivation (n = 565) and validation (n = 282) samples. Clinical, microbiological, and echocardiographic data were collected at admission. The primary endpoint was symptomatic embolism that occurred during the 6-month period after the initiation of treatment. The prediction model was developed and validated accounting for competing risks. Results The 6-month incidence of embolism was similar in the development and validation samples (8.5% in the 2 samples). Six variables were associated with ER and were used to create the calculator: age, diabetes, atrial fibrillation, embolism before antibiotics, vegetation length, and Staphylococcus aureus infection. There was an excellent correlation between the predicted and observed ER in both the development and validation samples. The C-statistics for the development and validation samples were 0.72 and 0.65, respectively. Finally, a significantly higher cumulative incidence of embolic events was observed in patients with high predicted ER in both the development (p < 0.0001) and validation (p < 0.05) samples. Conclusions The risk for embolism during infective endocarditis can be quantified at admission using a simple and accurate calculator. It might be useful for facilitating therapeutic decisions.
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2013.07.029