Early surgery versus conventional treatment for infective endocarditis.
BACKGROUND
The timing and indications for surgical intervention to prevent systemic embolism in infective endocarditis remain controversial. We conducted a trial to compare clinical outcomes of early surgery and conventional treatment in patients with infective endocarditis.


METHODS
We randomly assigned patients with left-sided infective endocarditis, severe valve disease, and large vegetations to early surgery (37 patients) or conventional treatment (39). The primary end point was a composite of in-hospital death and embolic events that occurred within 6 weeks after randomization.


RESULTS
All the patients assigned to the early-surgery group underwent valve surgery within 48 hours after randomization, whereas 30 patients (77%) in the conventional-treatment group underwent surgery during the initial hospitalization (27 patients) or during follow-up (3). The primary end point occurred in 1 patient (3%) in the early-surgery group as compared with 9 (23%) in the conventional-treatment group (hazard ratio, 0.10; 95% confidence interval [CI], 0.01 to 0.82; P=0.03). There was no significant difference in all-cause mortality at 6 months in the early-surgery and conventional-treatment groups (3% and 5%, respectively; hazard ratio, 0.51; 95% CI, 0.05 to 5.66; P=0.59). The rate of the composite end point of death from any cause, embolic events, or recurrence of infective endocarditis at 6 months was 3% in the early-surgery group and 28% in the conventional-treatment group (hazard ratio, 0.08; 95% CI, 0.01 to 0.65; P=0.02).


CONCLUSIONS
As compared with conventional treatment, early surgery in patients with infective endocarditis and large vegetations significantly reduced the composite end point of death from any cause and embolic events by effectively decreasing the risk of systemic embolism. (EASE ClinicalTrials.gov number, NCT00750373.).
Division of Cardiology, Asan Medical Center, University of Ulsan, Seoul, South Korea. dhkang@amc.seoul.kr
Duk-Hyun
DH
Kang
Yong-Jin
YJ
Kim
Sung-Han
SH
Kim
Byung Joo
BJ
Sun
Dae-Hee
DH
Kim
Sung-Cheol
SC
Yun
Jong-Min
JM
Song
Suk Jung
SJ
Choo
Cheol-Hyun
CH
Chung
Jae-Kwan
JK
Song
Jae-Won
JW
Lee
Dae-Won
DW
Sohn
D000328:Adult; D004617:Embolism / Q000517:prevention & control*; D004697:Endocarditis, Bacterial / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D055502:Secondary Prevention; D013997:Time Factors