TY - JOUR
T1 - Surgery and outcome of infective endocarditis in octogenarians
T2 - prospective data from the ESC EORP EURO-ENDO registry
AU - the EURO-ENDO Investigators group
AU - Pazdernik, Michal
AU - Iung, Bernard
AU - Mutlu, Bulent
AU - Alla, François
AU - Riezebos, Robert
AU - Kong, William
AU - Nunes, Maria Carmo Pereira
AU - Pierard, Luc
AU - Srdanovic, Ilija
AU - Yamada, Hirotsugu
AU - De Martino, Andrea
AU - Miglioranza, Marcelo Haertel
AU - Magne, Julien
AU - Piper, Cornelia
AU - Laroche, Cécile
AU - Maggioni, Aldo P.
AU - Lancellotti, Patrizio
AU - Habib, Gilbert
AU - Selton-Suty, Christine
AU - Ronderos, R.
AU - Avegliano, G.
AU - Oses, P. Fernandez
AU - Filipini, E.
AU - Granada, I.
AU - Iribarren, A.
AU - Mahia, M.
AU - Nacinovich, F.
AU - Ressi, S.
AU - Obregon, R.
AU - Bangher, M.
AU - Dho, J.
AU - Cartasegna, L.
AU - Plastino, M. L.
AU - Novas, V.
AU - Shigel, C.
AU - Reyes, G.
AU - De Santos, M.
AU - Gastaldello, N.
AU - Fernandez, M. Granillo
AU - Potito, M.
AU - Streitenberger, G.
AU - Velazco, P.
AU - Casabé, J. H.
AU - Cortes, C.
AU - Guevara, E.
AU - Salmo, F.
AU - Seijo, M.
AU - Weidinger, F.
AU - Heger, M.
AU - Al-Mallah, M.
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
PY - 2022/10
Y1 - 2022/10
N2 - PURPOSE: High mortality and a limited performance of valvular surgery are typical features of infective endocarditis (IE) in octogenarians, even though surgical treatment is a major determinant of a successful outcome in IE.METHODS: Data from the prospective multicentre ESC EORP EURO-ENDO registry were used to assess the prognostic role of valvular surgery depending on age.RESULTS: As compared to < 80 yo patients, ≥ 80 yo had lower rates of theoretical indication for valvular surgery (49.1% vs. 60.3%, p < 0.001), of surgery performed (37.0% vs. 75.5%, p < 0.001), and a higher in-hospital (25.9% vs. 15.8%, p < 0.001) and 1-year mortality (41.3% vs. 22.2%, p < 0.001). By multivariable analysis, age per se was not predictive of 1-year mortality, but lack of surgical procedures when indicated was strongly predictive (HR 2.98 [2.43-3.66]). By propensity analysis, 304 ≥ 80 yo were matched to 608 < 80 yo patients. Propensity analysis confirmed the lower rate of indication for valvular surgery (51.3% vs. 57.2%, p = 0.031) and of surgery performed (35.3% vs. 68.4%, p < 0.0001) in ≥ 80 yo. Overall mortality remained higher in ≥ 80 yo (in-hospital: HR 1.50[1.06-2.13], p = 0.0210; 1-yr: HR 1.58[1.21-2.05], p = 0.0006), but was not different from that of < 80 yo among those who had surgery (in-hospital: 19.7% vs. 20.0%, p = 0.4236; 1-year: 27.3% vs. 25.5%, p = 0.7176).CONCLUSION: Although mortality rates are consistently higher in ≥ 80 yo patients than in < 80 yo patients in the general population, mortality of surgery in ≥ 80 yo is similar to < 80 yo after matching patients. These results confirm the importance of a better recognition of surgical indication and of an increased performance of surgery in ≥ 80 yo patients.
AB - PURPOSE: High mortality and a limited performance of valvular surgery are typical features of infective endocarditis (IE) in octogenarians, even though surgical treatment is a major determinant of a successful outcome in IE.METHODS: Data from the prospective multicentre ESC EORP EURO-ENDO registry were used to assess the prognostic role of valvular surgery depending on age.RESULTS: As compared to < 80 yo patients, ≥ 80 yo had lower rates of theoretical indication for valvular surgery (49.1% vs. 60.3%, p < 0.001), of surgery performed (37.0% vs. 75.5%, p < 0.001), and a higher in-hospital (25.9% vs. 15.8%, p < 0.001) and 1-year mortality (41.3% vs. 22.2%, p < 0.001). By multivariable analysis, age per se was not predictive of 1-year mortality, but lack of surgical procedures when indicated was strongly predictive (HR 2.98 [2.43-3.66]). By propensity analysis, 304 ≥ 80 yo were matched to 608 < 80 yo patients. Propensity analysis confirmed the lower rate of indication for valvular surgery (51.3% vs. 57.2%, p = 0.031) and of surgery performed (35.3% vs. 68.4%, p < 0.0001) in ≥ 80 yo. Overall mortality remained higher in ≥ 80 yo (in-hospital: HR 1.50[1.06-2.13], p = 0.0210; 1-yr: HR 1.58[1.21-2.05], p = 0.0006), but was not different from that of < 80 yo among those who had surgery (in-hospital: 19.7% vs. 20.0%, p = 0.4236; 1-year: 27.3% vs. 25.5%, p = 0.7176).CONCLUSION: Although mortality rates are consistently higher in ≥ 80 yo patients than in < 80 yo patients in the general population, mortality of surgery in ≥ 80 yo is similar to < 80 yo after matching patients. These results confirm the importance of a better recognition of surgical indication and of an increased performance of surgery in ≥ 80 yo patients.
KW - Elderly
KW - Infective endocarditis
KW - Prognosis
KW - Propensity analysis
KW - Surgery
KW - Prospective Studies
KW - Hospital Mortality
KW - Humans
KW - Octogenarians
KW - Endocarditis/epidemiology
KW - Aged, 80 and over
KW - Endocarditis, Bacterial/epidemiology
KW - Registries
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U2 - 10.1007/s15010-022-01792-0
DO - 10.1007/s15010-022-01792-0
M3 - Article
C2 - 35290614
AN - SCOPUS:85127808545
SN - 0300-8126
VL - 50
SP - 1191
EP - 1202
JO - Infection
JF - Infection
IS - 5
ER -