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EASE: Early surgery after infective endocarditis diagnosis reduced complications
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AHA Scientific Sessions 2011
ORLANDO, Fla. — Surgery performed soon after the diagnosis of infective endocarditis helped eliminate the incidence of stroke, repeat infections and death.
Duk-Hyun Kang, MD, PhD, professor of medicine in the division of cardiology, University of Ulsan, Seoul, Korea, presented the first results of the Early Surgery vs. Conventional Treatment for Infective Endocarditis (EASE) trial at a late-breaking clinical trial session today.
The study included patients with left-sided native valve infective endocarditis accompanied by severe valve disease and a length of vegetation >10 mm who were diagnosed with infective endocarditis. Researchers randomly assigned patients to early surgery (n=37) or standard treatment (n=39). The early surgery group was prescribed antibiotics and underwent surgery immediately after diagnosis; the standard treatment group was prescribed only antibiotics. All patients in the intervention group underwent valve surgery within 48 hours after randomization; urgent or elective surgery was performed on only 77% of patients in the standard treatment group during initial hospitalization (n=27) or follow-up (n=3).
The primary endpoint of composite of in-hospital death and embolic events occurring within 6 weeks of randomization was observed in 2.7% patients in the early surgery group compared with 23.1% in the standard treatment group (HR=0.248; 95% CI, 0.069-0.883). Patients who underwent early surgery had no vascular obstruction, while five strokes and three arterial obstructions occurred in those on standard treatment.
At 6 months, the rate of composite of death for embolic events or recurrence of infective endocarditis was 2.7% in early surgery group vs. 28.2% in the standard treatment group (HR=0.083; 95% CI, 0.011-0.640). All-cause mortality at 6 months was higher in the standard treatment group (5.1%) vs. early surgery group (2.7%; HR=0.513; 95% CI, 0.047-5.662). Six months after treatment, none of the early surgery patients developed stroke or another infection whereas 23% of the standard treatment patients had embolic events. Data reveal no difference in baseline characteristics or 6-month all-cause mortality between the groups.
“In spite of the advances in medical and surgical treatment, infective endocarditis remains a serious disease that carries considerable mortality and morbidity,” Kang said at a press conference. “The role of surgery has been expanding in complicated infective endocarditis. However, the randomized clinical trial has been conducted to clarify the optimal timing and indications for surgical intervention to prevent systemic embolism in infective endocarditis.” – by Casey Murphy
For more information:
- Kang DH. LBCT.05. Presented at: American Heart Association Scientific Sessions 2011; Nov. 12-16, 2011; Orlando, Fla.
Disclosure: Dr. Kang reports no relevant financial disclosures.
Infective endocarditis is a challenging clinical problem, certainly after the diagnosis is confirmed. Critical decision-making around the country centers around the timing of surgery and the impact of surgical comorbidities. What Dr. Kang and his associates have demonstrated is that early surgery can be done with significant improvements in outcome vs. conventional antibiotic followed by surgery later. Reducing the number of strokes, reducing the number of current infections and showing no impact on the operative mortality suggests that this is a change in the paradigm for the management of this disease.
Robert Higgins, MD
Professor of Surgery
Ohio
State University
Disclosure: Dr. Higgins reports no relevant financial disclosures.
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