TY - JOUR
T1 - Incidence, risk factors, and predictors of infective endocarditis in adult congenital heart disease
T2 - Focus on the use of prosthetic material
AU - Kuijpers, Joey M.
AU - Koolbergen, Dave R.
AU - Groenink, Maarten
AU - Peels, Kathinka C.H.
AU - Reichert, Constant L.A.
AU - Post, Marco C.
AU - Bosker, Hans A.
AU - Wajon, Elly M.C.J.
AU - Zwinderman, Aeilko H.
AU - Mulder, Barbara J.M.
AU - Bouma, Berto J.
N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: [email protected].
PY - 2017/7/7
Y1 - 2017/7/7
N2 - Aims: Adult congenital heart disease (ACHD) predisposes to infective endocarditis (IE). Surgical advancements have changed the ACHD population, whereas associated prosthetic material may constitute additional IE targets. We aimed to prospectively determine contemporary incidence, risk factors, and predictors of IE in a nationwide ACHD cohort, focusing on the presence of prosthetics. Methods and results: We identified 14 224 patients prospectively followed in the CONCOR ACHD registry (50.5% female, median age 33.6years). IE incidence was determined using Poisson regression, risk factors and predictors using Cox regression. Overall incidence was 1.33 cases/1000 person-years (124 cases in 93 562 person-years). For risk-factor analysis, presence of prosthetics was forced - as separate time-updated variables for specific prosthetics - into a model with baseline characteristics univariably associated with IE. Valve-containing prosthetics were independently associated with greater risk both short- and long term after implantation [0-6 months: hazard ratio (HR) = 17.29; 7.34-40.70, 6-12 months: HR = 15.91; 6.76-37.45, beyond 12 months: HR = 5.26; 3.52-7.86], non-valve-containing prosthetics, including valve repair, only in the first 6 months after implantation (HR = 3.34; 1.33-8.41), not thereafter. A prediction model was derived and validated using bootstrapping techniques. Independent predictors of IE were baseline valve-containing prosthetics, main congenital heart defect, multiple defects, previous IE, and sex. The model had fair discriminative ability and provided accurate predictions up to 10 years. Conclusions: This study provides IE incidence estimates, and determinants of IE risk in a nationwide ACHD cohort. Our findings, essentially informing IE prevention guidelines, indicate valve-containing prosthetics as a main determinant of IE risk whereas other prosthetics, including valve-repair, are not associated with increased risk long term after implantation.
AB - Aims: Adult congenital heart disease (ACHD) predisposes to infective endocarditis (IE). Surgical advancements have changed the ACHD population, whereas associated prosthetic material may constitute additional IE targets. We aimed to prospectively determine contemporary incidence, risk factors, and predictors of IE in a nationwide ACHD cohort, focusing on the presence of prosthetics. Methods and results: We identified 14 224 patients prospectively followed in the CONCOR ACHD registry (50.5% female, median age 33.6years). IE incidence was determined using Poisson regression, risk factors and predictors using Cox regression. Overall incidence was 1.33 cases/1000 person-years (124 cases in 93 562 person-years). For risk-factor analysis, presence of prosthetics was forced - as separate time-updated variables for specific prosthetics - into a model with baseline characteristics univariably associated with IE. Valve-containing prosthetics were independently associated with greater risk both short- and long term after implantation [0-6 months: hazard ratio (HR) = 17.29; 7.34-40.70, 6-12 months: HR = 15.91; 6.76-37.45, beyond 12 months: HR = 5.26; 3.52-7.86], non-valve-containing prosthetics, including valve repair, only in the first 6 months after implantation (HR = 3.34; 1.33-8.41), not thereafter. A prediction model was derived and validated using bootstrapping techniques. Independent predictors of IE were baseline valve-containing prosthetics, main congenital heart defect, multiple defects, previous IE, and sex. The model had fair discriminative ability and provided accurate predictions up to 10 years. Conclusions: This study provides IE incidence estimates, and determinants of IE risk in a nationwide ACHD cohort. Our findings, essentially informing IE prevention guidelines, indicate valve-containing prosthetics as a main determinant of IE risk whereas other prosthetics, including valve-repair, are not associated with increased risk long term after implantation.
KW - Adult
KW - Congenital heart defect
KW - Epidemiology
KW - Prosthetic material
KW - Surgery
KW - Endocarditis/complications
KW - Humans
KW - Middle Aged
KW - Risk Factors
KW - Male
KW - Incidence
KW - Heart Valve Prosthesis/adverse effects
KW - Prosthesis-Related Infections/epidemiology
KW - Young Adult
KW - Heart Defects, Congenital/complications
KW - Europe/epidemiology
KW - Female
KW - Registries
KW - Cohort Studies
UR - http://www.scopus.com/inward/record.url?scp=85019902369&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/ehw591
DO - 10.1093/eurheartj/ehw591
M3 - Article
C2 - 28065906
AN - SCOPUS:85019902369
SN - 0195-668X
VL - 38
SP - 2048
EP - 2056
JO - European Heart Journal
JF - European Heart Journal
IS - 26
ER -