Clinical Outcome of Native Valve Infective Endocarditis in Khon Kaen: 1990-1999
ORA THAI PACHIRAT, M.D.*, PYATAT TASANAVIVAT,M.D.*, VIRA T KLUNGBOONKRONG, M.D., F.A.C.C.*, PLOENCHAN CHETCHOTISAKD, M.D.**, CHERDCHAI TANTISIRIN, M.D.***, SUPON LIMWATTANANON, M.P.H.M., Ph.D.****, PRA WIT TA WEESANGSUKSAKUL, M.D.*****
Affiliation : * Division of Cardiovascular Disease and Internal Medicine, Khon Kaen University, ** Division of Infectious Disease, Department of Medicine, Khon Kaen University. *** Cardiovascular Thoracic Unit, Department of Surgery, Khon Kaen University, **** Department of Community Pharmacy, Faculty ofPharmaceuticle Sciences, Khon Kaen University, ***** Cardiovascular Unit, Khon Kaen Provincial Hospital, Khon Kaen 40002, Thailand.
Objective : To compare the survival of infective endocarditis (IE) patients following dif ferent treatment strategies and to determine the predictors of patient survival. Background : IE is a life~threatening infectious disease that is often difficult to manage. Studies on long-term outcome are limited.
Method : Data on 152 patients with IE from 1990 to 1999 were collected from two hos pitals. The main outcome is death after definite diagnosis of native valve IE.
Results : The overall case fatality rate was 38 per 100 patient-years. Survival curves showed better survival for patients treated with surgery compared with patients treated medically (p <0.0001 ). Survival rate at year 1 was 72 per cent for surgically treated patients and 33 per cent for medically treated patients. Five-year survival rates were 66 per cent and 27 per cent in the two groups, respectively. Based on Cox proportional hazards regression analysis, surgery to be an inde = pendent predictor of survival (relative risk [RR] 0.23; 95% confidence interval [CI] 0.14 to 0.39, p <0.0001), while the presence of congestive heart failure (RR = 2.55; 95% CI 1.61 to 4.02, p = <0.0001), and being male (RR 1.76; 95% CI 1.04 to 2.82, p <0.05) were independent predictors of mortality.
Conclusion : Patients with native valve endocarditis have a high long-term mortality rate. The most common types of cardiac death are post-operative and sudden death. Surgical treatment was the preventive factor of mortality.
Keywords : Infective Endocarditis, Long-Term Study, Long-term Survival
