The aim of the ESC EURObservational Research Programme (EORP) European Endocarditis (EURO-ENDO) international registry was to study the treatment and outcomes of 3,111 patients prospectively identified with infective endocarditis (IE) between 2016 and 2018.1 This registry has already been the source of several valuable publications, and today, an oral presentation by Doctor Joost van Melle (University Medical Center Groningen, Netherlands) describes the findings of an analysis of patients with adult congenital heart disease (ACHD) included in the ESC-EORP EURO-ENDO registry.
The pre-specified ancillary analysis compared 365 patients with ACHD and 2,746 patients without ACHD in terms of baseline characteristics and 1-year outcomes. Compared with non-ACHD patients, those with ACHD were younger (mean age 44.8 years) and had fewer comorbidities. In the 6 months before hospitalisation, more patients with ACHD had had a dental procedure compared with non-ACHD patients (14% vs. 7%; p<0.001) and more often had positive blood cultures for Streptococcus viridans (16.4% vs. 8.8%; p<0.001).
Patients with ACHD had lower in-hospital mortality than those without ACHD (9.0% vs. 18.1%; p<0.001) and 1-year mortality was more favourable (adjusted hazard ratio [HR] 0.70; 95% confidence interval 0.51 to 0.95). Within the ACHD population, multivariate Cox regression revealed that fistula (HR 6.97), failure to undertake surgery when indicated (HR 5.93), cerebral embolus (HR 4.64), renal insufficiency (HR 3.44) and Staphylococcus aureus (HR 2.06) were predictors of mortality.
To conclude, although ACHD patients with IE had better outcomes than non-ACHD patients, the observed high incidence of dental procedures prior to IE warrants further interest in antibiotic prophylaxis for patients with ACHD.
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