Surgical outcomes of infective endocarditis among intravenous drug users

Joon Bum Kim, Julius I. Ejiofor, Maroun Yammine, Masahiko Ando, Janice M. Camuso, Ilan Youngster, Sandra B. Nelson, Arthur Y. Kim, Serguei I. Melnitchouk, James D. Rawn, Thomas E. MacGillivray, Lawrence H. Cohn, John G. Byrne, Thoralf M. Sundt

Research output: Contribution to journalArticlepeer-review

Abstract

Background With increasing prevalence of injected drug use in the United States, a growing number of intravenous drug users (IVDUs) are at risk for infective endocarditis (IE) that may require surgical intervention; however, few data exist about clinical outcomes of these individuals. Methods We evaluated consecutive adult patients undergoing surgery for active IE between 2002 and 2014 pooled from 2 prospective institutional databases. Death and valve-related events, including reinfection or heart valve reoperation, thromboembolism, and anticoagulation-related hemorrhage were evaluated. Results Of the 436 patients identified, 78 (17.9%) were current IVDUs. The proportion of IVDUs increased from 14.8% in 2002 to 2004 to 26.1% in 2012 to 2014. IVDUs were younger (aged 35.9 ± 9.9 years vs 59.3 ± 14.1 years) and had fewer cardiovascular risk factors than non-IVDUs. During follow-up (median, 29.4 months; quartile 1-3, 4.7-72.6 months), adverse events among all patients included death in 92, reinfection in 42, valve-reoperation in 35, thromboembolism in 17, and hemorrhage in 16. Operative mortality was lower among IVDUs (odds ratio, 0.25; 95% confidence interval [CI], 0.06-0.71), but overall mortality was not significantly different (hazard ratio [HR], 0.78; 95% CI, 0.44-1.37). When baseline profiles were adjusted by propensity score, IVDUs had higher risk of valve-related complications (HR, 3.82; 95% CI, 1.95-7.49; P < .001) principally attributable to higher rates of reinfection (HR, 6.20; 95% CI, 2.56-15.00; P < .001). Conclusions The proportion of IVDUs among surgically treated IE patients is increasing. Although IVDUs have lower operative risk, long-term outcomes are compromised by reinfection.

Original languageEnglish
Pages (from-to)832-841.e1
JournalJournal of Thoracic and Cardiovascular Surgery
Volume152
Issue number3
DOIs
StatePublished - 2016
Externally publishedYes

Keywords

  • infective endocarditis
  • intravenous drug use
  • operative risk
  • valvular heart disease

Fingerprint

Dive into the research topics of 'Surgical outcomes of infective endocarditis among intravenous drug users'. Together they form a unique fingerprint.

Cite this