Researchers wanted to determine if stroke severity influenced clinical outcomes in patients with infective endocarditis (IE) and cerebral sequelae and if early surgery in the active phase had an effect on long-term prognosis in individuals with non-severe neurologic abnormalities. From 1990 to 2014, researchers evaluated clinical data from 170 individuals with active left-sided IE and cerebral sequelae. The average age was 60 ± 17 years, and 93 (55%) were men. The stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). A composite of IE-related death, repeat surgery, and recurrence of IE was characterized as a major adverse cardiac event.
The NIHSS score at the start was closely linked to clinical outcomes. When patients were separated into two groups according to the NIHSS, 33 had a severe stroke (NIHSS≥11), and 137 had a nonsevere stroke (NIHSS≤10); patients with powerful stroke had a considerably reduced risk of IE-related death and major adverse cardiac events than those with nonsevere stroke. In a study of 137 individuals with non-severe stroke, 65 underwent early surgery within two weeks after onset, while 72 received standard care. Patients who had early surgery had a considerably lower risk of dying from IE than those who had traditional treatment (P=.007). Furthermore, an adjusted survival analysis utilizing the inverse probability treatment weighting approach revealed that early surgery had a substantial favorable effect in lowering IE-related death in patients (P=.012). Early surgery may be advantageous in patients who have had a non-severe stroke.
Reference:www.jtcvs.org/article/S0022-5223(16)31481-7/fulltext
