L-1521. Embolic Complications of Infective Endocarditis (IE): Report on 709 IE Episodes of the Italian Study on Endocarditis (SEI)
Session: Poster Session: Treatment of Endovascular Infections
Sunday, October 26, 2008: 12:00 AM
Room: Hall C
Background: embolic events are a major cause of morbidity and mortality in IE. Our goal was to assess the incidence, clinical characteristics, and outcome of stroke/TIA (Transient Ischemic Attack) and peripheral/pulmonary embolism in IE. Methods: the SEI group is prospectively collecting data on IE episodes at 18 Italian institutions. From 1/1/2004 through 31/3/2008, 791 consecutive IE episodes were reported (709 definite episodes and 82 possible episodes, Duke criteria). All the definite episodes were included in this analysis. Results: overall, 296 patients (41.7%) had one or more embolic event. CNS embolism occurred in 126 pts (17.8%), with 16 TIAs, 110 strokes (71.8% ischemic, 20.9% hemorrhagic, 7.3% unknown); peripheral/pulmonary embolism occurred in 230 pts (32.4%): spleen 79 pts, lungs 71 pts, limbs 43 pts, spine 33 pts, others 14 pts.
Embolism was more common in native valve endocarditis with 279 episodes (92 in the CNS, 187 peripheral) involving 43.8% of the pts; in prosthetic valve endocarditis 75 episodes were observed (32 in the CNS, 43 peripheral; 35.4% of the pts). The risk of TIA/stroke was higher with mitral valve involvement (21.6%; RR 1.3) and Staphylococcus aureus etiology (56.7%; RR 1.2, p<0.05). TIA/stroke and peripheral/pulmonary embolism were associated with an increased risk of death (20.6%, compared to 13.6% in non embolic pts; RR 1.5, p<0.05). Pts on anticoagulants had a higher incidence of CNS embolism (19.5% versus 16.9%, RR 1.2), and a higher mortality when embolism occurred (61.3% versus 23.7%; RR 2.6, p<0.01). Conclusions: embolism is a frequent complication of IE, is more common in mitral valve IE and S. aureus infection, and is associated with a high mortality.
Emanuele Durante-Mangoni1, Fredy Suter, MD2, Gianni Gattuso3, Marco Rizzi, MD4, Mario Venditti, MD5, Massimo Crapis6, Nicola Petrosillo7, Roberto Stellini8, Valerio Del Bono9, Veronica Ravasio, MD2 and  M. Rizzi, None., (1)AO Monaldi, (2)Ospedali Riuniti, (3)AO Poma, (4)Ospedali Riuniti, Bergamo, Italy, (5)Policl. Umberto I, (6)Policl. Universitario, (7)INMI Spallanzani, (8)Spedali Civili, (9)UniversitÓ