title: Reduced valve replacement surgery and complication rate in Staphylococcus aureus endocarditis patients receiving acetyl-salicylic acid.
abstract: 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.
authors.affiliation: Victorian Infectious Diseases Service, Royal Melbourne Hospital, Grattan St, Parkville, Victoria 3050, Australia. damon.eisen@mh.org.au
authors.forename: Damon P
authors.initials: DP
authors.lastname: Eisen
authors.forename: G Ralph
authors.initials: GR
authors.lastname: Corey
authors.forename: Emma S
authors.initials: ES
authors.lastname: McBryde
authors.forename: Vance G
authors.initials: VG
authors.lastname: Fowler
authors.forename: Jose M
authors.initials: JM
authors.lastname: Miro
authors.forename: Chris H
authors.initials: CH
authors.lastname: Cabell
authors.forename: Alan C
authors.initials: AC
authors.lastname: Street
authors.forename: Marcelo Goulart
authors.initials: MG
authors.lastname: Paiva
authors.forename: Adina
authors.initials: A
authors.lastname: Ionac
authors.forename: Ru-San
authors.initials: RS
authors.lastname: Tan
authors.forename: Christophe
authors.initials: C
authors.lastname: Tribouilloy
authors.forename: Orathai
authors.initials: O
authors.lastname: Pachirat
authors.forename: Sandra Braun
authors.initials: SB
authors.lastname: Jones
authors.forename: Natalia
authors.initials: N
authors.lastname: Chipigina
authors.forename: Christoph
authors.initials: C
authors.lastname: Naber
authors.forename: Angelo
authors.initials: A
authors.lastname: Pan
authors.forename: Veronica
authors.initials: V
authors.lastname: Ravasio
authors.forename: Rainer
authors.initials: R
authors.lastname: Gattringer
authors.forename: Vivian H
authors.initials: VH
authors.lastname: Chu
authors.forename: Arnold S
authors.initials: AS
authors.lastname: Bayer