Age, sex, diabetes, aortic regurgitation severity linked to infective endocarditis risk after TAVR
Younger age, male sex, history of diabetes and moderate to severe residual aortic regurgitation were significantly linked to a higher risk for infective endocarditis among patients undergoing transcatheter aortic valve replacement, according to findings published in JAMA.
The study also found that patients who developed infective endocarditis had high rates of in-hospital mortality and 2-year mortality.
Ander Regueiro, MD, from the Quebec Heart and Lung Institute, Laval University, Quebec City, and colleagues sought to find relevant factors, clinical characteristics and outcomes in patients with infective endocarditis after TAVR.
The researchers analyzed data from 20,006 patients at 47 worldwide centers in the Infectious Endocarditis after TAVR International Registry from June 2005 to October 2015.
From that cohort, the researchers found infective endocarditis occurred in 250 patients (incidence = 1.1% per person-year; 95% CI, 1.1-1.4; median age, 80 years; 64% men). Median time from TAVR to infective endocarditis was 5.3 months (interquartile range, 1.5-13.4).
Younger age (78.9 years vs. 81.8 years; HR = 0.97 per year; 95% CI, 0.94-0.99) was linked to a higher risk for infective endocarditis after TAVR, as were male sex (62% vs. 49.7%; HR = 1.69; 95% CI, 1.13-2.52), diabetes (41.7% vs. 30%; HR = 1.52; 95% CI, 1.02-2.29) and moderate to severe aortic regurgitation (22.4% vs. 14.7%; HR = 2.05; 95% CI, 1.28-1.38).
The in-hospital mortality rate was 36% (95% CI, 30-41.9; 90 deaths, 160 survivors), with surgery required in 14.8% (95% CI, 10.4-19.2) during the episode of infective endocarditis, according to the researchers. The 2-year mortality rate was 66.7% (95% CI, 59-74.2; 132 deaths, 115 survivors).
In-hospital mortality was linked to a higher logistic EuroSCORE (23.1% vs. 18.6%; OR = 1.03 per 1% increase; 95% CI, 1-1.05), HF (59.3% vs. 23.7%; OR = 3.36; 95% CI, 1.74-6.45) and acute kidney injury (67.4% vs. 31.6%; OR = 2.7; 95% CI, 1.42-5.11), Regueiro and colleagues found.
Among those with infective endocarditis, 52.8% (95% CI, 46.6-59) had health care-associated infective endocarditis, with Enterococcus (24.6%; 95% CI, 19.1-30.1) and Staphylococcus aureus (23.3%; 95% CI, 17.9-28.7) being the most frequently identified microorganisms.
“This study confirms the high rate of morbidity and mortality of infective endocarditis after TAVR and provides novel information about the timing, causative organisms and predictive factors of infective endocarditis in this particular population,” the researchers wrote. “This ... may help the clinicians identify patients at higher risk and aid in implementing appropriate preventive measures.” – by James Clark
Disclosure: Regueiro reports receiving a grant from the Fundacion Alfonso Martin Escudero. Please see the full study for a list of the other researchers’ relevant financial disclosures.