Impact of early surgery vs conventional treatment for infective endocarditis on mortality and embolic events: data from EASE trial

• Prospective RCT (2006-2011); median follow-up: 749 days

• N=76 pts with left-sided infective endocarditis, severe mitral or aortic valve disease and vegetations with diameter >10 mm

• Pts randomised to early surgery (within 48h after randomisation) (N=37) or conventional treatment* (based on current AHA guidelines) (N=39)

• Primary endpoint: composite of in-hospital death and embolic events occurring within 6 wk after randomisation

• No significant ≠ in baseline characteristics between both groups

Kang DH et al. N Engl J Med 2012;366:2466-73

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*Surgery performed only in case of complications during medical treatment or in case of persistent symptoms after completion of antibiotic therapy

Primary endpoint (6 wk)

Secondary endpoints (6 mo)

Impact of early surgery vs conventional treatment for infective endocarditis on mortality and embolic events: data from EASE trial

Compared with conventional treatment, early surgery significantly reduces the combined risk of death from any cause and embolic events, by decreasing

the risk of systemic embolism

Kang DH et al. N Engl J Med 2012;366:2466-73

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Impact of timing of cardiac surgery on mortality in pts with infective endocarditis and ischaemic stroke

• Multi-centre retrospective cohort study (data from International Collaboration on Endocarditis-Prospective Cohort Study; 2000-2006)

• N=198 pts with infective endocarditis (IE) complicated by ischaemic cardiac stroke, who underwent post-stroke valve replacement surgery

• Treatment groups:

– Early surgery: Within 1-7 days after cardiac stroke: N=58 (29.3%)

– Late surgery: >7 days after cardiac stroke: N=140 (70.7%)

Multivariable logistic regression Potential predictors of in-hospital mortality

Barsic B et al. Clin Infect Dis 2013;56:209-17

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Kaplan-Meier analysis/Cox regression analysis

Potential predictors of 1-year mortality

Impact of timing of cardiac surgery on mortality in pts with infective endocarditis and ischaemic stroke

In pts with IE and stroke, delaying cardiac surgery may not significantly reduce in-hospital or 1-year mortality compared with early surgery

Barsic B et al. Clin Infect Dis 2013;56:209-17

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