Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Long-Term Results of Early Surgery versus Conventional Treatment for Infective Endocarditis Trial

  • Kang, Duk-Hyun (Division of Cardiology, Cardiac Surgery, Infectious Disease, Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Lee, Sahmin (Division of Cardiology, Cardiac Surgery, Infectious Disease, Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Kim, Yong-Jin (Cardiovascular Center, Seoul National University Hospital, Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Kim, Sung-Han (Division of Cardiology, Cardiac Surgery, Infectious Disease, Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Kim, Dae-Hee (Division of Cardiology, Cardiac Surgery, Infectious Disease, Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Yun, Sung-Cheol (Division of Cardiology, Cardiac Surgery, Infectious Disease, Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Song, Jong-Min (Division of Cardiology, Cardiac Surgery, Infectious Disease, Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Chung, Cheol-Hyun (Division of Cardiology, Cardiac Surgery, Infectious Disease, Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Song, Jae-Kwan (Division of Cardiology, Cardiac Surgery, Infectious Disease, Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan) ;
  • Lee, Jae-Won (Division of Cardiology, Cardiac Surgery, Infectious Disease, Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan)
  • Received : 2016.04.10
  • Accepted : 2016.05.27
  • Published : 2016.11.30
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Abstract

Background and Objectives: Compared with conventional treatment, early surgery significantly reduced the composite end point of all-cause death and embolic events during hospitalization, but long-term data in this area are lacking. This study sought to compare long-term outcomes of early surgery with a conventional treatment strategy in patients with infective endocarditis (IE) and large vegetations. Subjects and Methods: The Early Surgery versus Conventional Treatment in Infective Endocarditis (EASE) trial randomly assigned patients with left-sided IE, severe valve disease and large vegetation to early surgery (37 patients) or conventional treatment groups (39 patients). The pre-specified end points were all-cause death, embolic events, recurrence of IE and repeat hospitalizations due to the development of congestive heart failure occurring during follow-up. Results: There were no significant differences between the early surgery and the conventional treatment group in all-cause mortality at 4 years (8.1% and 7.7%, respectively; hazard ratio [HR] 1.04; 95% CI, 0.21 to 5.15; p=0.96). The rate of the composite end point of death from any cause, embolic events or recurrence of IE at 4 years was 8.1% in the early surgery group and 30.8% in the conventional treatment group (HR, 0.22; 95% CI, 0.06-0.78; p=0.02). The estimated actuarial rate of end points at 7 years was significantly lower in the early surgery group than in the conventional treatment group (log-rank p=0.007). Conclusion: There was a substantial benefit in having early surgery for patients with IE and large vegetations whose health was sustained up to 7 years, and late clinical outcome after surgery was excellent in survivors of IE. (EASE clinicaltrials.gov identifier: NCT00750373)

Keywords

References

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