[Acute coronary syndrome in infective endocarditis].
OBJECTIVE
To describe the clinical, microbiologic, echocardiographic characteristics, and disease progression in patients who experience an acute coronary syndrome during an episode of endocarditis.


METHODS
The study included 586 consecutive patients who were diagnosed of infective endocarditis (481 left-sided) at one of five hospitals between 1995 and 2005.


RESULTS
Overall, 14 patients (2.9%) had an acute coronary syndrome. Their mean age was 50 (17) years, and 50% had a prosthetic valve. For 11 episodes of endocarditis, laboratory cultures tested positive, with Staphylococcus aureus being the most frequently isolated microorganism. Vegetations were detected by transesophageal echography in 12 cases. The infection was located in the aortic valve in 12 cases. In the 14 patients, periannular complications were found more frequently (11 [78.6%] vs 172 [36.8%]; P=.03), and their size was greater than in other patients. Thirteen had moderate-to-severe valvular regurgitation. In most patients, acute coronary syndrome was an early complication of endocarditis. Myocardial ischemia was due to an embolism in three cases and to coronary artery compression in eight. During follow-up, patients with acute coronary syndrome had higher incidences of heart failure (6 [42.85%] vs 77 [16.48%]; P=.021), cardiogenic shock (5 [35.7%] vs 71 [15.2%]; P=.038), complete atrioventricular block (4 [28.57%] vs 43 [9.2%]; P=.039), and mortality (9 [64.29%] vs 151 [32.33%]; P=.019).


CONCLUSIONS
Acute coronary syndrome is usually an early complication of infective endocarditis. It is associated with virulent microorganisms, aortic valve infection, severe valvular regurgitation, extensive periannular complications, and increased mortality. The most frequent cause of myocardial ischemia was coronary artery compression secondary to periannular complications.
Manzano
María Carmen
MC
Instituto Cardiovascular, Hospital Universitario San Carlos, Madrid, Spain. mcmanzano@lycos.es
Vilacosta
Isidre
I
San Román
José A
JA
Aragoncillo
Paloma
P
Sarriá
Cristina
C
López
Daniel
D
López
Javier
J
Revilla
Ana
A
Manchado
Rocío
R
Hernández
Rosana
R
Rodríguez
Enrique
E
D000368:Aged; D000789:Angina, Unstable / Q000209:etiology* / Q000628:therapy; D001021:Aortic Valve; D016009:Chi-Square Distribution; D004617:Embolism / Q000209:etiology / Q000601:surgery; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000382:microbiology / Q000601:surgery; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000628:therapy; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D013577:Syndrome