Association Between Transcatheter Aortic Valve Replacement and Subsequent Infective Endocarditis and In-Hospital Death

Ander Regueiro; Axel Linke; Azeem Latib; Nikolaj Ihlemann; Marina Urena; Thomas Walther; Oliver Husser; Howard C Herrmann; Luis Nombela-Franco; Asim N Cheema; Hervé Le Breton; Stefan Stortecky; Samir Kapadia; Antonio L Bartorelli; Jan-Malte Sinning; Ignacio Amat-Santos; Antonio Munoz-Garcia; Stamatios Lerakis; Enrique Gutiérrez-Ibanes; Mohamed Abdel-Wahab; Didier Tchetche; Luca Testa; Hélène Eltchaninoff; Ugolino Livi; Juan Carlos Castillo; Hasan Jilaihawi; John G Webb; Marco Barbanti; Susheel Kodali; Fabio S de Brito; Henrique B Ribeiro; Antonio Miceli; Claudia Fiorina; Guglielmo Mario Actis Dato; Francesco Rosato; Vicenç Serra; Jean-Bernard Masson; Harindra C Wijeysundera; Jose A Mangione; Maria-Cristina Ferreira; Valter C Lima; Luiz A Carvalho; Alexandre Abizaid; Marcos A Marino; Vinicius Esteves; Julio C M Andrea; Francesco Giannini; David Messika-Zeitoun; Dominique Himbert; Won-Keun Kim; Costanza Pellegrini; Vincent Auffret; Fabian Nietlispach; Thomas Pilgrim; Eric Durand; John Lisko; Raj R Makkar; Pedro A Lemos; Martin B Leon; Rishi Puri; Alberto San Roman; Alec Vahanian; Lars Søndergaard; Norman Mangner; Josep Rodés-Cabau

doi:10.1001/jama.2016.12347

Association Between Transcatheter Aortic Valve Replacement and Subsequent Infective Endocarditis and In-Hospital Death

Ander Regueiro, Axel Linke, Azeem Latib, Nikolaj Ihlemann, Marina Urena, Thomas Walther, Oliver Husser, Howard C Herrmann, Luis Nombela-Franco, Asim N Cheema, Hervé Le Breton, Stefan Stortecky, Samir Kapadia, Antonio L Bartorelli, Jan-Malte Sinning, Ignacio Amat-Santos, Antonio Munoz-Garcia, Stamatios Lerakis, Enrique Gutiérrez-Ibanes, Mohamed Abdel-WahabDidier Tchetche, Luca Testa, Hélène Eltchaninoff, Ugolino Livi, Juan Carlos Castillo, Hasan Jilaihawi, John G Webb, Marco Barbanti, Susheel Kodali, Fabio S de Brito, Henrique B Ribeiro, Antonio Miceli, Claudia Fiorina, Guglielmo Mario Actis Dato, Francesco Rosato, Vicenç Serra, Jean-Bernard Masson, Harindra C Wijeysundera, Jose A Mangione, Maria-Cristina Ferreira, Valter C Lima, Luiz A Carvalho, Alexandre Abizaid, Marcos A Marino, Vinicius Esteves, Julio C M Andrea, Francesco Giannini, David Messika-Zeitoun, Dominique Himbert, Won-Keun Kim, Costanza Pellegrini, Vincent Auffret, Fabian Nietlispach, Thomas Pilgrim, Eric Durand, John Lisko, Raj R Makkar, Pedro A Lemos, Martin B Leon, Rishi Puri, Alberto San Roman, Alec Vahanian, Lars Søndergaard, Norman Mangner, Josep Rodés-Cabau

Department of Clinical Medicine

145 Citations (Scopus)

Abstract

IMPORTANCE: Limited data exist on clinical characteristics and outcomes of patients who had infective endocarditis after undergoing transcatheter aortic valve replacement (TAVR).

OBJECTIVE: To determine the associated factors, clinical characteristics, and outcomes of patients who had infective endocarditis after TAVR.

DESIGN, SETTING, AND PARTICIPANTS: The Infectious Endocarditis after TAVR International Registry included patients with definite infective endocarditis after TAVR from 47 centers from Europe, North America, and South America between June 2005 and October 2015.

EXPOSURE: Transcatheter aortic valve replacement for incidence of infective endocarditis and infective endocarditis for in-hospital mortality.

MAIN OUTCOMES AND MEASURES: Infective endocarditis and in-hospital mortality after infective endocarditis.

RESULTS: A total of 250 cases of infective endocarditis occurred in 20 006 patients after TAVR (incidence, 1.1% per person-year; 95% CI, 1.1%-1.4%; median age, 80 years; 64% men). Median time from TAVR to infective endocarditis was 5.3 months (interquartile range [IQR], 1.5-13.4 months). The characteristics associated with higher risk of progressing to infective endocarditis after TAVR was younger age (78.9 years vs 81.8 years; hazard ratio [HR], 0.97 per year; 95% CI, 0.94-0.99), male sex (62.0% vs 49.7%; HR, 1.69; 95% CI, 1.13-2.52), diabetes mellitus (41.7% vs 30.0%; HR, 1.52; 95% CI, 1.02-2.29), and moderate to severe aortic regurgitation (22.4% vs 14.7%; HR, 2.05; 95% CI, 1.28-3.28). Health care-associated infective endocarditis was present in 52.8% (95% CI, 46.6%-59.0%) of patients. Enterococci species and Staphylococcus aureus were the most frequently isolated microorganisms (24.6%; 95% CI, 19.1%-30.1% and 23.3%; 95% CI, 17.9%-28.7%, respectively). The in-hospital mortality rate was 36% (95% CI, 30.0%-41.9%; 90 deaths; 160 survivors), and surgery was performed in 14.8% (95% CI, 10.4%-19.2%) of patients during the infective endocarditis episode. In-hospital mortality was associated with a higher logistic EuroSCORE (23.1% vs 18.6%; odds ratio [OR], 1.03 per 1% increase; 95% CI, 1.00-1.05), heart failure (59.3% vs 23.7%; OR, 3.36; 95% CI, 1.74-6.45), and acute kidney injury (67.4% vs 31.6%; OR, 2.70; 95% CI, 1.42-5.11). The 2-year mortality rate was 66.7% (95% CI, 59.0%-74.2%; 132 deaths; 115 survivors).

CONCLUSIONS AND RELEVANCE: Among patients undergoing TAVR, younger age, male sex, history of diabetes mellitus, and moderate to severe residual aortic regurgitation were significantly associated with an increased risk of infective endocarditis. Patients who developed endocarditis had high rates of in-hospital mortality and 2-year mortality.

Original language	English
Journal	J A M A: The Journal of the American Medical Association
Volume	316
Issue number	10
Pages (from-to)	1083-1092
Number of pages	10
ISSN	0098-7484
DOIs	https://doi.org/10.1001/jama.2016.12347
Publication status	Published - 13 Sept 2016

Keywords

Age Factors
Aged
Endocarditis
Endocarditis, Bacterial
Female
Follow-Up Studies
Heart Failure
Hospital Mortality
Humans
Male
Odds Ratio
Registries
Risk Factors
Sex Factors
Staphylococcal Infections
Staphylococcus aureus
Transcatheter Aortic Valve Replacement
Treatment Outcome
Journal Article
Multicenter Study

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Regueiro, A., Linke, A., Latib, A., Ihlemann, N., Urena, M., Walther, T., Husser, O., Herrmann, H. C., Nombela-Franco, L., Cheema, A. N., Le Breton, H., Stortecky, S., Kapadia, S., Bartorelli, A. L., Sinning, J-M., Amat-Santos, I., Munoz-Garcia, A., Lerakis, S., Gutiérrez-Ibanes, E., ... Rodés-Cabau, J. (2016). Association Between Transcatheter Aortic Valve Replacement and Subsequent Infective Endocarditis and In-Hospital Death. J A M A: The Journal of the American Medical Association, 316(10), 1083-1092. https://doi.org/10.1001/jama.2016.12347

Regueiro, A, Linke, A, Latib, A, Ihlemann, N, Urena, M, Walther, T, Husser, O, Herrmann, HC, Nombela-Franco, L, Cheema, AN, Le Breton, H, Stortecky, S, Kapadia, S, Bartorelli, AL, Sinning, J-M, Amat-Santos, I, Munoz-Garcia, A, Lerakis, S, Gutiérrez-Ibanes, E, Abdel-Wahab, M, Tchetche, D, Testa, L, Eltchaninoff, H, Livi, U, Castillo, JC, Jilaihawi, H, Webb, JG, Barbanti, M, Kodali, S, de Brito, FS, Ribeiro, HB, Miceli, A, Fiorina, C, Dato, GMA, Rosato, F, Serra, V, Masson, J-B, Wijeysundera, HC, Mangione, JA, Ferreira, M-C, Lima, VC, Carvalho, LA, Abizaid, A, Marino, MA, Esteves, V, Andrea, JCM, Giannini, F, Messika-Zeitoun, D, Himbert, D, Kim, W-K, Pellegrini, C, Auffret, V, Nietlispach, F, Pilgrim, T, Durand, E, Lisko, J, Makkar, RR, Lemos, PA, Leon, MB, Puri, R, San Roman, A, Vahanian, A, Søndergaard, L, Mangner, N & Rodés-Cabau, J 2016, 'Association Between Transcatheter Aortic Valve Replacement and Subsequent Infective Endocarditis and In-Hospital Death', J A M A: The Journal of the American Medical Association, vol. 316, no. 10, pp. 1083-1092. https://doi.org/10.1001/jama.2016.12347

@article{d9abaf1ade9a42be8bbf2593956659e6,

title = "Association Between Transcatheter Aortic Valve Replacement and Subsequent Infective Endocarditis and In-Hospital Death",

abstract = "IMPORTANCE: Limited data exist on clinical characteristics and outcomes of patients who had infective endocarditis after undergoing transcatheter aortic valve replacement (TAVR).OBJECTIVE: To determine the associated factors, clinical characteristics, and outcomes of patients who had infective endocarditis after TAVR.DESIGN, SETTING, AND PARTICIPANTS: The Infectious Endocarditis after TAVR International Registry included patients with definite infective endocarditis after TAVR from 47 centers from Europe, North America, and South America between June 2005 and October 2015.EXPOSURE: Transcatheter aortic valve replacement for incidence of infective endocarditis and infective endocarditis for in-hospital mortality.MAIN OUTCOMES AND MEASURES: Infective endocarditis and in-hospital mortality after infective endocarditis.RESULTS: A total of 250 cases of infective endocarditis occurred in 20 006 patients after TAVR (incidence, 1.1% per person-year; 95% CI, 1.1%-1.4%; median age, 80 years; 64% men). Median time from TAVR to infective endocarditis was 5.3 months (interquartile range [IQR], 1.5-13.4 months). The characteristics associated with higher risk of progressing to infective endocarditis after TAVR was younger age (78.9 years vs 81.8 years; hazard ratio [HR], 0.97 per year; 95% CI, 0.94-0.99), male sex (62.0% vs 49.7%; HR, 1.69; 95% CI, 1.13-2.52), diabetes mellitus (41.7% vs 30.0%; HR, 1.52; 95% CI, 1.02-2.29), and moderate to severe aortic regurgitation (22.4% vs 14.7%; HR, 2.05; 95% CI, 1.28-3.28). Health care-associated infective endocarditis was present in 52.8% (95% CI, 46.6%-59.0%) of patients. Enterococci species and Staphylococcus aureus were the most frequently isolated microorganisms (24.6%; 95% CI, 19.1%-30.1% and 23.3%; 95% CI, 17.9%-28.7%, respectively). The in-hospital mortality rate was 36% (95% CI, 30.0%-41.9%; 90 deaths; 160 survivors), and surgery was performed in 14.8% (95% CI, 10.4%-19.2%) of patients during the infective endocarditis episode. In-hospital mortality was associated with a higher logistic EuroSCORE (23.1% vs 18.6%; odds ratio [OR], 1.03 per 1% increase; 95% CI, 1.00-1.05), heart failure (59.3% vs 23.7%; OR, 3.36; 95% CI, 1.74-6.45), and acute kidney injury (67.4% vs 31.6%; OR, 2.70; 95% CI, 1.42-5.11). The 2-year mortality rate was 66.7% (95% CI, 59.0%-74.2%; 132 deaths; 115 survivors).CONCLUSIONS AND RELEVANCE: Among patients undergoing TAVR, younger age, male sex, history of diabetes mellitus, and moderate to severe residual aortic regurgitation were significantly associated with an increased risk of infective endocarditis. Patients who developed endocarditis had high rates of in-hospital mortality and 2-year mortality.",

keywords = "Age Factors, Aged, Endocarditis, Endocarditis, Bacterial, Female, Follow-Up Studies, Heart Failure, Hospital Mortality, Humans, Male, Odds Ratio, Registries, Risk Factors, Sex Factors, Staphylococcal Infections, Staphylococcus aureus, Transcatheter Aortic Valve Replacement, Treatment Outcome, Journal Article, Multicenter Study",

author = "Ander Regueiro and Axel Linke and Azeem Latib and Nikolaj Ihlemann and Marina Urena and Thomas Walther and Oliver Husser and Herrmann, {Howard C} and Luis Nombela-Franco and Cheema, {Asim N} and {Le Breton}, Herv{\'e} and Stefan Stortecky and Samir Kapadia and Bartorelli, {Antonio L} and Jan-Malte Sinning and Ignacio Amat-Santos and Antonio Munoz-Garcia and Stamatios Lerakis and Enrique Guti{\'e}rrez-Ibanes and Mohamed Abdel-Wahab and Didier Tchetche and Luca Testa and H{\'e}l{\`e}ne Eltchaninoff and Ugolino Livi and Castillo, {Juan Carlos} and Hasan Jilaihawi and Webb, {John G} and Marco Barbanti and Susheel Kodali and {de Brito}, {Fabio S} and Ribeiro, {Henrique B} and Antonio Miceli and Claudia Fiorina and Dato, {Guglielmo Mario Actis} and Francesco Rosato and Vicen{\c c} Serra and Jean-Bernard Masson and Wijeysundera, {Harindra C} and Mangione, {Jose A} and Maria-Cristina Ferreira and Lima, {Valter C} and Carvalho, {Luiz A} and Alexandre Abizaid and Marino, {Marcos A} and Vinicius Esteves and Andrea, {Julio C M} and Francesco Giannini and David Messika-Zeitoun and Dominique Himbert and Won-Keun Kim and Costanza Pellegrini and Vincent Auffret and Fabian Nietlispach and Thomas Pilgrim and Eric Durand and John Lisko and Makkar, {Raj R} and Lemos, {Pedro A} and Leon, {Martin B} and Rishi Puri and {San Roman}, Alberto and Alec Vahanian and Lars S{\o}ndergaard and Norman Mangner and Josep Rod{\'e}s-Cabau",

year = "2016",

month = sep,

day = "13",

doi = "10.1001/jama.2016.12347",

language = "English",

volume = "316",

pages = "1083--1092",

journal = "J A M A: The Journal of the American Medical Association",

issn = "0098-7484",

publisher = "American Medical Association",

number = "10",

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TY - JOUR

T1 - Association Between Transcatheter Aortic Valve Replacement and Subsequent Infective Endocarditis and In-Hospital Death

AU - Regueiro, Ander

AU - Linke, Axel

AU - Latib, Azeem

AU - Ihlemann, Nikolaj

AU - Urena, Marina

AU - Walther, Thomas

AU - Husser, Oliver

AU - Herrmann, Howard C

AU - Nombela-Franco, Luis

AU - Cheema, Asim N

AU - Le Breton, Hervé

AU - Stortecky, Stefan

AU - Kapadia, Samir

AU - Bartorelli, Antonio L

AU - Sinning, Jan-Malte

AU - Amat-Santos, Ignacio

AU - Munoz-Garcia, Antonio

AU - Lerakis, Stamatios

AU - Gutiérrez-Ibanes, Enrique

AU - Abdel-Wahab, Mohamed

AU - Tchetche, Didier

AU - Testa, Luca

AU - Eltchaninoff, Hélène

AU - Livi, Ugolino

AU - Castillo, Juan Carlos

AU - Jilaihawi, Hasan

AU - Webb, John G

AU - Barbanti, Marco

AU - Kodali, Susheel

AU - de Brito, Fabio S

AU - Ribeiro, Henrique B

AU - Miceli, Antonio

AU - Fiorina, Claudia

AU - Dato, Guglielmo Mario Actis

AU - Rosato, Francesco

AU - Serra, Vicenç

AU - Masson, Jean-Bernard

AU - Wijeysundera, Harindra C

AU - Mangione, Jose A

AU - Ferreira, Maria-Cristina

AU - Lima, Valter C

AU - Carvalho, Luiz A

AU - Abizaid, Alexandre

AU - Marino, Marcos A

AU - Esteves, Vinicius

AU - Andrea, Julio C M

AU - Giannini, Francesco

AU - Messika-Zeitoun, David

AU - Himbert, Dominique

AU - Kim, Won-Keun

AU - Pellegrini, Costanza

AU - Auffret, Vincent

AU - Nietlispach, Fabian

AU - Pilgrim, Thomas

AU - Durand, Eric

AU - Lisko, John

AU - Makkar, Raj R

AU - Lemos, Pedro A

AU - Leon, Martin B

AU - Puri, Rishi

AU - San Roman, Alberto

AU - Vahanian, Alec

AU - Søndergaard, Lars

AU - Mangner, Norman

AU - Rodés-Cabau, Josep

PY - 2016/9/13

Y1 - 2016/9/13

N2 - IMPORTANCE: Limited data exist on clinical characteristics and outcomes of patients who had infective endocarditis after undergoing transcatheter aortic valve replacement (TAVR).OBJECTIVE: To determine the associated factors, clinical characteristics, and outcomes of patients who had infective endocarditis after TAVR.DESIGN, SETTING, AND PARTICIPANTS: The Infectious Endocarditis after TAVR International Registry included patients with definite infective endocarditis after TAVR from 47 centers from Europe, North America, and South America between June 2005 and October 2015.EXPOSURE: Transcatheter aortic valve replacement for incidence of infective endocarditis and infective endocarditis for in-hospital mortality.MAIN OUTCOMES AND MEASURES: Infective endocarditis and in-hospital mortality after infective endocarditis.RESULTS: A total of 250 cases of infective endocarditis occurred in 20 006 patients after TAVR (incidence, 1.1% per person-year; 95% CI, 1.1%-1.4%; median age, 80 years; 64% men). Median time from TAVR to infective endocarditis was 5.3 months (interquartile range [IQR], 1.5-13.4 months). The characteristics associated with higher risk of progressing to infective endocarditis after TAVR was younger age (78.9 years vs 81.8 years; hazard ratio [HR], 0.97 per year; 95% CI, 0.94-0.99), male sex (62.0% vs 49.7%; HR, 1.69; 95% CI, 1.13-2.52), diabetes mellitus (41.7% vs 30.0%; HR, 1.52; 95% CI, 1.02-2.29), and moderate to severe aortic regurgitation (22.4% vs 14.7%; HR, 2.05; 95% CI, 1.28-3.28). Health care-associated infective endocarditis was present in 52.8% (95% CI, 46.6%-59.0%) of patients. Enterococci species and Staphylococcus aureus were the most frequently isolated microorganisms (24.6%; 95% CI, 19.1%-30.1% and 23.3%; 95% CI, 17.9%-28.7%, respectively). The in-hospital mortality rate was 36% (95% CI, 30.0%-41.9%; 90 deaths; 160 survivors), and surgery was performed in 14.8% (95% CI, 10.4%-19.2%) of patients during the infective endocarditis episode. In-hospital mortality was associated with a higher logistic EuroSCORE (23.1% vs 18.6%; odds ratio [OR], 1.03 per 1% increase; 95% CI, 1.00-1.05), heart failure (59.3% vs 23.7%; OR, 3.36; 95% CI, 1.74-6.45), and acute kidney injury (67.4% vs 31.6%; OR, 2.70; 95% CI, 1.42-5.11). The 2-year mortality rate was 66.7% (95% CI, 59.0%-74.2%; 132 deaths; 115 survivors).CONCLUSIONS AND RELEVANCE: Among patients undergoing TAVR, younger age, male sex, history of diabetes mellitus, and moderate to severe residual aortic regurgitation were significantly associated with an increased risk of infective endocarditis. Patients who developed endocarditis had high rates of in-hospital mortality and 2-year mortality.

AB - IMPORTANCE: Limited data exist on clinical characteristics and outcomes of patients who had infective endocarditis after undergoing transcatheter aortic valve replacement (TAVR).OBJECTIVE: To determine the associated factors, clinical characteristics, and outcomes of patients who had infective endocarditis after TAVR.DESIGN, SETTING, AND PARTICIPANTS: The Infectious Endocarditis after TAVR International Registry included patients with definite infective endocarditis after TAVR from 47 centers from Europe, North America, and South America between June 2005 and October 2015.EXPOSURE: Transcatheter aortic valve replacement for incidence of infective endocarditis and infective endocarditis for in-hospital mortality.MAIN OUTCOMES AND MEASURES: Infective endocarditis and in-hospital mortality after infective endocarditis.RESULTS: A total of 250 cases of infective endocarditis occurred in 20 006 patients after TAVR (incidence, 1.1% per person-year; 95% CI, 1.1%-1.4%; median age, 80 years; 64% men). Median time from TAVR to infective endocarditis was 5.3 months (interquartile range [IQR], 1.5-13.4 months). The characteristics associated with higher risk of progressing to infective endocarditis after TAVR was younger age (78.9 years vs 81.8 years; hazard ratio [HR], 0.97 per year; 95% CI, 0.94-0.99), male sex (62.0% vs 49.7%; HR, 1.69; 95% CI, 1.13-2.52), diabetes mellitus (41.7% vs 30.0%; HR, 1.52; 95% CI, 1.02-2.29), and moderate to severe aortic regurgitation (22.4% vs 14.7%; HR, 2.05; 95% CI, 1.28-3.28). Health care-associated infective endocarditis was present in 52.8% (95% CI, 46.6%-59.0%) of patients. Enterococci species and Staphylococcus aureus were the most frequently isolated microorganisms (24.6%; 95% CI, 19.1%-30.1% and 23.3%; 95% CI, 17.9%-28.7%, respectively). The in-hospital mortality rate was 36% (95% CI, 30.0%-41.9%; 90 deaths; 160 survivors), and surgery was performed in 14.8% (95% CI, 10.4%-19.2%) of patients during the infective endocarditis episode. In-hospital mortality was associated with a higher logistic EuroSCORE (23.1% vs 18.6%; odds ratio [OR], 1.03 per 1% increase; 95% CI, 1.00-1.05), heart failure (59.3% vs 23.7%; OR, 3.36; 95% CI, 1.74-6.45), and acute kidney injury (67.4% vs 31.6%; OR, 2.70; 95% CI, 1.42-5.11). The 2-year mortality rate was 66.7% (95% CI, 59.0%-74.2%; 132 deaths; 115 survivors).CONCLUSIONS AND RELEVANCE: Among patients undergoing TAVR, younger age, male sex, history of diabetes mellitus, and moderate to severe residual aortic regurgitation were significantly associated with an increased risk of infective endocarditis. Patients who developed endocarditis had high rates of in-hospital mortality and 2-year mortality.

KW - Age Factors

KW - Aged

KW - Endocarditis

KW - Endocarditis, Bacterial

KW - Female

KW - Follow-Up Studies

KW - Heart Failure

KW - Hospital Mortality

KW - Humans

KW - Male

KW - Odds Ratio

KW - Registries

KW - Risk Factors

KW - Sex Factors

KW - Staphylococcal Infections

KW - Staphylococcus aureus

KW - Transcatheter Aortic Valve Replacement

KW - Treatment Outcome

KW - Journal Article

KW - Multicenter Study

U2 - 10.1001/jama.2016.12347

DO - 10.1001/jama.2016.12347

M3 - Journal article

C2 - 27623462

SN - 0098-7484

VL - 316

SP - 1083

EP - 1092

JO - J A M A: The Journal of the American Medical Association

JF - J A M A: The Journal of the American Medical Association

IS - 10

ER -

Association Between Transcatheter Aortic Valve Replacement and Subsequent Infective Endocarditis and In-Hospital Death

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Keywords

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