Reduced valve replacement surgery and complication rate in Staphylococcus aureus endocarditis patients receiving acetyl-salicylic acid.
OBJECTIVE
To assess the influence of acetyl-salicylic acid (ASA) on clinical outcomes in Staphylococcus aureus infective endocarditis (SA-IE).


METHODS
The International Collaboration on Endocarditis - Prospective Cohort Study database was used in this observational study. Multivariable analysis of the SA-IE cohort compared outcomes in patients with and without ASA use, adjusting for other predictive variables, including: age, diabetes, hemodialysis, cancer, pacemaker, intracardiac defibrillator and methicillin resistance.


RESULTS
Data were analysed from 670 patients, 132 of whom were taking ASA at the time of SA-IE diagnosis. On multivariable analysis, ASA usage was associated with a significantly decreased overall rate of acute valve replacement surgery (OR 0.58 [95% CI 0.35-0.97]; p<0.04), particularly where valvular regurgitation, congestive heart failure or periannular abscess was the indication for such surgery (OR 0.46 [0.25-0.86]; p<0.02). There was no reduction in the overall rates of clinically apparent embolism with prior ASA usage, and no increase in hemorrhagic strokes in ASA-treated patients.


CONCLUSIONS
In this multinational prospective observational cohort, recent ASA usage was associated with a reduced occurrence of acute valve replacement surgery in SA-IE patients. Future investigations should focus on ASA's prophylactic and therapeutic use in high-risk and newly diagnosed patients with SA bacteremia and SA-IE, respectively.
Eisen
Damon P
DP
Victorian Infectious Diseases Service, Royal Melbourne Hospital, Grattan St, Parkville, Victoria 3050, Australia. damon.eisen@mh.org.au
Corey
G Ralph
GR
McBryde
Emma S
ES
Fowler
Vance G
VG
Miro
Jose M
JM
Cabell
Chris H
CH
Street
Alan C
AC
Paiva
Marcelo Goulart
MG
Ionac
Adina
A
Tan
Ru-San
RS
Tribouilloy
Christophe
C
Pachirat
Orathai
O
Jones
Sandra Braun
SB
Chipigina
Natalia
N
Naber
Christoph
C
Pan
Angelo
A
Ravasio
Veronica
V
Gattringer
Rainer
R
Chu
Vivian H
VH
Bayer
Arnold S
AS