Outcomes after early or late timing of surgery for infective endocarditis with ischaemic stroke: a retrospective cohort study

Abstract

Objectives: The timing of cardiac surgery for infective endocarditis with ischaemic stroke remains controversial.

Methods: Using a nationwide inpatient database in Japan, we conducted a retrospective observational study. We identified patients aged 20 years or older with ischaemic stroke on admission who were diagnosed with infective endocarditis and underwent cardiac surgery during the initial hospitalization between July 2010 and March 2013. In-hospital mortality and perioperative complications were compared between the early (≤7 days) and late (>7 days) surgery groups using logistic regression analyses with adjustment for propensity scores and inverse probability of treatment weighting.

Results: We identified 253 patients who underwent cardiac valve surgery for infective endocarditis with ischaemic stroke on admission. In-hospital mortality rates were 8.6 and 9.5% in the early (n = 105) and late (n = 148) surgery groups, respectively. There were no significant differences in the in-hospital mortality between the early and late surgery groups in the propensity score-adjusted model [odds ratio (OR), 0.95; 95% confidence interval (CI), 0.35-2.54] and inverse probability-weighted model (risk difference, -0.82%; 95% CI, -6.43 to 4.84%). The perioperative complication rates were 42.9 and 37.8% in the early and late surgery groups, respectively, and showed no significant differences in the propensity score-adjusted model (OR, 1.11; 95% CI, 0.63-1.97) and inverse probability-weighted model (risk difference, 1.54%; 95% CI, -7.13 to 10.2%).

Conclusions: Early timing of surgery for infective endocarditis patients with ischaemic stroke was not associated with higher in-hospital mortality or complications after admission. Early timing of surgery may not be contraindicated for infective endocarditis patients with ischaemic stroke.

Keywords: Complications; Endocarditis (all infectious agents); Stroke; Surgery.