ORLANDO, FLA. — Surgery soon after diagnosis of a heart infection eliminated the incidence of strokes and repeat infections, researchers said in a late-breaking presentation at the American Heart Association’s Scientific Sessions 2011.
Infective endocarditis — infection of tissues lining the heart, including the valves — is uncommon but serious. It affects about 29,000 people in the United States each year.
Researchers report the first randomized study comparing standard treatment (antibiotics, with surgery only for severe cases) to antibiotics plus surgery soon after diagnosis.
A main cause of infective endocarditis is bacteria that enter the bloodstream and lodge in the heart tissue in patients with a pre-existing heart condition. Complications include stroke, infections in other parts of the body or heart failure. The condition is often fatal if left untreated, and effective antibiotic treatment is critical. Early surgery is generally reserved for patients in whom medicines didn’t treat the problem completely or who have other complications.
“We found that early surgery — within 48 hours of diagnosis of infective endocarditis — is clinically feasible,” said Duk-Hyun Kang, M.D, Ph.D., study author and professor of medicine in the Division of Cardiology at Asian Medical Center and the College of Medicine, University of Ulsan in Seoul, Korea.
“It can be an option to further improve clinical outcome in infective endocarditis, which is associated with considerable mortality and morbidity that has not improved significantly despite advances in medical and surgical treatment.”
In the new study, researchers randomly assigned 76 patients to receive either surgery to remove infected tissue and repair damage within 48 hours of diagnosis or standard treatment, which includes antibiotics and surgery only in severe cases unresponsive to antibiotics or in those with other life-threatening complications. The participants were diagnosed with infective endocarditis and severe valve disease at two centers in Seoul between September 2006 and September 2011. Sixty-nine percent of the participants were male and average age was 48 years.
Among the patients, 77 percent in the standard therapy group had urgent or elective surgery an average of fifteen days after diagnosis. Early-surgery patients underwent surgical repair one day after diagnosis.
Researchers, analyzing the data on rate of death and arterial obstruction due to emboli by six weeks after surgery, found that:
- Patients who underwent early surgery had no vascular obstruction, while five strokes and three arterial obstructions occurred among those on standard treatment.
- The in-hospital death rate in the two groups was the same at 3 percent.
- Six months after treatment, none of the early-surgery patients had developed stroke or another infection. In contrast, 23 percent of those who received standard therapy developed complications (eight embolic events ― five of these cerebral, one recurrence of endocarditis and two deaths).
- Death rates were similar for the two groups: 3 percent for early surgery and 5 percent for standard treatment.
Following American Heart Association guidelines, patients in both groups received intravenous antibiotics for four to six weeks after diagnosis.
Co-authors are Yong-Jin Kim, M.D., Ph.D.; Sung-Han Kim, M.D., Ph.D.; Byung Joo Sun, M.D.; Dae-Hee Kim, M.D., Ph.D.; Sung-Cheol Yun, Ph.D.; Jong-Min Song, M.D., Ph.D.; Suk Jung Choo, M.D., Ph.D.; Cheol-Hyun Chung, M.D., Ph.D.; Jae-Kwan Song, M.D., Ph.D.; Jae-Won Lee, M.D., Ph.D.; and Dae-Won Sohn, M.D., Ph.D.
Disclosures are here: http://newsroom.heart.org/pr/aha/document/Disclosures_for_LBCT.xlsx.
Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding .
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