• DOI:10.1056/NEJMoa1112843
• Corpus ID: 205094082

Early surgery versus conventional treatment for infective endocarditis.

@article{Kang2012EarlySV,
  title={Early surgery versus conventional treatment for infective endocarditis.},
  author={Duk Hyun Kang and Yong-Jin Kim and Sung-Han Kim and Byung Joo Sun and Dae‐Hee Kim and Sung-Cheol Yun and Jong-Min Song and Suk Jung Choo and Cheol Hyun Chung and Jae-Kwan Song and Jae-Won Lee and Dae-Won Sohn},
  journal={The New England journal of medicine},
  year={2012},
  volume={366 26},
  pages={
          2466-73
        }
}

• D. Kang, Yong-Jin Kim, +9 authors D. Sohn
• Published 27 June 2012
• Medicine
• The New England journal of medicine

BACKGROUND
The timing and indications for surgical intervention to prevent systemic embolism in infective endocarditis remain controversial. We conducted a trial to compare clinical outcomes of early surgery and conventional treatment in patients with infective endocarditis.

METHODS
We randomly assigned patients with left-sided infective endocarditis, severe valve disease, and large vegetations to early surgery (37 patients) or conventional treatment (39). The primary end point was a composite of in-hospital death and embolic events that occurred within 6 weeks after randomization.

RESULTS
All the patients assigned to the early-surgery group underwent valve surgery within 48 hours after randomization, whereas 30 patients (77%) in the conventional-treatment group underwent surgery during the initial hospitalization (27 patients) or during follow-up (3). The primary end point occurred in 1 patient (3%) in the early-surgery group as compared with 9 (23%) in the conventional-treatment group (hazard ratio, 0.10; 95% confidence interval [CI], 0.01 to 0.82; P=0.03). There was no significant difference in all-cause mortality at 6 months in the early-surgery and conventional-treatment groups (3% and 5%, respectively; hazard ratio, 0.51; 95% CI, 0.05 to 5.66; P=0.59). The rate of the composite end point of death from any cause, embolic events, or recurrence of infective endocarditis at 6 months was 3% in the early-surgery group and 28% in the conventional-treatment group (hazard ratio, 0.08; 95% CI, 0.01 to 0.65; P=0.02).

CONCLUSIONS
As compared with conventional treatment, early surgery in patients with infective endocarditis and large vegetations significantly reduced the composite end point of death from any cause and embolic events by effectively decreasing the risk of systemic embolism. (EASE ClinicalTrials.gov number, NCT00750373.).