Journal article
Incidence, Predictors, and Outcomes of Endocarditis After Transcatheter Aortic Valve Replacement in the United States
JACC. Cardiovascular interventions, Vol.13(17), pp.1973-1982
09/14/2020
DOI: 10.1016/j.jcin.2020.05.012
PMCID: PMC7490767
PMID: 32912457
Abstract
OBJECTIVES This study sought to evaluate the incidence and outcomes of endocarditis after transcatheter aortic valve replacement (TAVR).
BACKGROUND Data about endocarditis after TAVR are limited.
METHODS The study investigated Medicare patients who underwent TAVR from 2012 to 2017 and identified patients admitted with endocarditis during follow-up using a validated algorithm. The main study outcome was all-cause mortality.
RESULTS Of 134,717 patients who underwent TAVR, 1868 patients developed endocarditis during follow-up (incidence 0.87%/year), with majority of infections (65.0%) occurring within 1 year. Incidence of endocarditis declined in recent years. The most common organisms were Staphylococcus (22.0%), Streptococcus (20.0%), and Enterococcus (15.5%). Important predictors for endocarditis were younger age at TAVR, mate sex, prior endocarditis, end-stage renal disease, repeat TAVR procedures, liver and lung disease, and post-TAVR acute kidney injury. Thirty-day and 1-year mortality were 18.5% and 45.6%, respectively. After adjusting for comorbidities and procedural complications, endocarditis after TAVR was associated with 3-fold higher risk of mortality (44.9 vs. 16.2 deaths per 100 person-years; adjusted hazard ratio [aHR]: 2.94; 95% confidence interval [CI]: 2.77 to 3.12; p < 0.0001). End-stage renal disease (aHR: 2.12; 95% CI: 1.72 to 2.60), endocarditis complicated by cardiogenic shock (aHR: 2.50, 95% 0: 1.56 to 4.02), ischemic stroke (aHR: 1.56; 95% CI: 1.07 to 2.28), intracerebral hemorrhage (aHR: 1.67; 95% CI: 1.01 to 2.76), acute kidney injury (aHR: 1.44; 95% CI: 1.27 to 1.63), blood transfusion (aHR: 1.28; 95% CI: 1.09 to 1.50), staphylococcal (aHR: 1.71; 95% 0: 1.49 to 1.97), and fungal endocarditis (aHR: 1.72; 95% CI: 1.23 to 2.39) (p < 0.05 for all) portended higher mortality following endocarditis.
CONCLUSIONS The incidence of endocarditis after TAVR is low and declining. However, it is associated with poor prognosis with one-half the patients dying within 1 year. (C) 2020 by the American College of Cardiology Foundation.
Details
- Title: Subtitle
- Incidence, Predictors, and Outcomes of Endocarditis After Transcatheter Aortic Valve Replacement in the United States
- Creators
- Amgad Mentias - Roy J. and Lucille A. Carver College of MedicineSaket Girotra - Roy J. and Lucille A. Carver College of MedicineMilind Y. Desai - Cleveland ClinicPhillip A. Horwitz - Roy J. and Lucille A. Carver College of MedicineJames D. Rossen - Roy J. and Lucille A. Carver College of MedicineMarwan Saad - Brown UniversitySidakpal Panaich - Roy J. and Lucille A. Carver College of MedicineSamir Kapadia - Cleveland ClinicMary Vaughan Sarrazin - Univ Iowa, Carver Coll Med, Div Cardiovasc Med, Iowa City, IA 52242 USA
- Resource Type
- Journal article
- Publication Details
- JACC. Cardiovascular interventions, Vol.13(17), pp.1973-1982
- DOI
- 10.1016/j.jcin.2020.05.012
- PMID
- 32912457
- PMCID
- PMC7490767
- NLM abbreviation
- JACC Cardiovasc Interv
- ISSN
- 1936-8798
- eISSN
- 1876-7605
- Publisher
- Elsevier
- Number of pages
- 10
- Grant note
- R01AG055663-01 / National InstituteonAging; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Aging (NIA) Health Services Research and Development Service of the Department of Veterans Affairs; US Department of Veterans Affairs
- Language
- English
- Date published
- 09/14/2020
- Academic Unit
- Neurology; Health Management and Policy; Cardiovascular Medicine; General Internal Medicine; Neurosurgery; Internal Medicine
- Record Identifier
- 9984303017002771
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