Mortality and Clinical Outcomes in Infective Endocarditis According To Management Strategy: From Conventional Treatment To Structural Intervention
DOI:
https://doi.org/10.67440/ahj.vi.2794Keywords:
Infective Endocarditis, Mortality, Cardiac Surgery, Management Strategy, Transcatheter Intervention, Prosthetic-Valve Endocarditis, Intravenous Drug Use.Abstract
Background: Infective endocarditis (IE) is a heterogeneous and potentially fatal cardiovascular infection in which treatment decisions depend on infection control, valve or structural damage, hemodynamic consequences, embolic risk, and operative or interventional feasibility.
Objective: To compare mortality and major clinical outcomes among patients with IE managed medically, surgically, or by transcatheter intervention, and to compare major clinical and echocardiographic outcomes across the management groups.
Methods: This prospective, single-center analytical cohort included patients with possible or definitive IE presenting to Cairo University Hospitals between May 2023 and February 2025. Patients were classified according to the management strategy ultimately received: medical management (Group 1), surgical management (Group 2), or transcatheter intervention management (Group 3). The transcatheter intervention pathway was reserved for selected patients with an IE-related hemodynamically significant lesion considered suitable for percutaneous correction, together with high surgical risk or refusal of surgery, and without an urgent or emergent surgical indication. Clinical, echocardiographic, anatomical, and outcome data were compared across the three groups.
Results: The final cohort comprised 120 patients: 62 managed medically, 38 surgically, and 20 by transcatheter intervention. Mortality was 0%, 55.3%, and 10.0%, respectively (P<0.001). Heart failure occurred in 46.8%, 52.6%, and 65.0% (P=0.362), major embolization in 30.6%, 21.1%, and 55.0% (P=0.030), and acute kidney injury in 32.3%, 34.2%, and 45.0% (P=0.579). Important differences were also observed in atrial fibrillation, previous IE, prosthetic-valve IE, intravenous drug use, right-sided IE, and tricuspid involvement.
Conclusion: Mortality and clinical phenotype differed substantially among the three management groups. The observed mortality gradient should not be interpreted as evidence of treatment superiority because treatment allocation was clinically determined and the groups differed markedly in baseline characteristics. The findings support individualized multidisciplinary management and provide hypotheses for larger studies with more robust adjustment for baseline risk.
