Characteristics and Outcomes of Operated Versus Nonoperated Patients With Infective Endocarditis and Cerebral Complications: The COOPER Study

IF 5.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Canadian Journal of Cardiology Pub Date : 2026-10-01 Epub Date: 2026-03-19 DOI:10.1016/j.cjca.2026.03.022

Olivia Graveleau MD, Johann Cattan MD, Gaultier Marnat MD, Melchior Jonveaux MD, Marina Dijos MD, Marine Bouchat MD, Guillaume Bonnet MD, PhD, Lionel Leroux MD, PhD, Mathieu Pernot MD, PhD, Julien Peltan MD, Georgios Nesseris MD, Louis Labrousse MD, PhD, Benjamin Seguy MD, Edouard Gerbaud MD, PhD, Soumaya Sridi-Cheniti MD, Hélène Chaussade MD, Carine Greib MD, Fabrice Camou MD, Olivia Peuchant PharmD, PhD, Gaetane Wirth MD, Julien Ternacle MD, PhD

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引用次数: 0

Abstract

Background

Cerebral complications in patients with infective endocarditis (IE) are common and worsen prognosis. Determining the optimal timing for cardiac surgery in this context remains challenging. In this study we describe the characteristics and outcomes of IE patients with cerebral complications who were managed either surgically or medically.

Methods

We analyzed all consecutive patients with IE-related cerebral complications enrolled in a prospective cohort study in Aquitaine, France (2013-2021). Patients were classified as operated or nonoperated. The primary outcome was all-cause mortality at 1 month; secondary outcomes included all-cause mortality up to 1 year and the impact of cerebral lesion type and surgical timing.

Results

Among 1230 IE patients, 288 had cerebral complications (age 65 ± 14 years, 74% male). Ischemic and hemorrhagic cerebral lesions occurred in 76% and 19% of patients, respectively. Severe valvular damages were present in 43% and cardiac surgery was indicated in 86% of cases. One-month mortality was significantly higher among nonoperated vs operated patients (27% vs 5.9%, P < 0.001). Multivariate analysis identified heart failure, coma, and cardiac surgery (odds ratio 0.24, 95% confidence interval 0.10-0.56, P < 0.001) as independent predictors of mortality. Neither the type of cerebral lesion nor surgical timing appeared to affect prognosis.

Conclusions

When indicated, cardiac surgery should be systematically discussed in IE patients with cerebral complications. Early intervention guided by a multidisciplinary endocarditis team with neurology expertise may improve outcomes.

查看原文本刊更多论文

感染性心内膜炎和脑并发症手术与非手术患者的特点和结果：COOPER研究。

背景：感染性心内膜炎（IE）患者常见脑并发症，且预后较差。在这种情况下，确定心脏手术的最佳时机仍然具有挑战性。本研究旨在描述伴有脑并发症的IE患者的特征和结果，无论是手术还是药物治疗。方法：我们分析了2013-2021年在法国阿基坦的前瞻性队列中所有连续的ie相关脑并发症患者。患者分为手术组和非手术组。主要转归是1个月时的全因死亡率；次要结局包括长达1年的全因死亡率以及脑病变类型和手术时间的影响。结果：1230例IE患者中，288例出现脑并发症（年龄65±14岁，男性占74%）。缺血性和出血性脑损伤发生率分别为76%和19%。43%的病例存在严重的瓣膜损伤，86%的病例需要进行心脏手术。非手术患者的1个月死亡率明显高于手术患者（27% vs. 5.9%）。结论：在有脑并发症的IE患者中，应系统地讨论心脏手术。由包括神经学专家在内的多学科心内膜炎小组指导的早期干预可能会改善结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Canadian Journal of Cardiology 医学-心血管系统

CiteScore

9.20

自引率

8.10%

发文量

546

审稿时长

32 days

期刊介绍： The Canadian Journal of Cardiology (CJC) is the official journal of the Canadian Cardiovascular Society (CCS). The CJC is a vehicle for the international dissemination of new knowledge in cardiology and cardiovascular science, particularly serving as the major venue for Canadian cardiovascular medicine.