%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Hubert, S.
%A Thuny, F.
%A Resseguier, N.
%A Giorgi, R.
%A Tribouilloy, C.
%A Le Dolley, Y.
%A Casalta, J. P.
%A Riberi, A.
%A Chevalier, F.
%A Rusinaru, D.
%A Malaquin, D.
%A Remadi, J. P.
%A Ben Ammar, A.
%A Avierinos, J. F.
%A Collart, F.
%A Raoult, Didier
%A Habib, G.
%T Prediction of symptomatic embolism in infective endocarditis
%D 2013
%L PAR00010934
%G ENG
%J Journal of the American College of Cardiology
%@ 0735-1097
%K embolism ; endocarditis ; prognosis
%M ISI:000325005000015
%N 15
%P 1384-1392
%R 10.1016/j.jacc.2013.07.029
%U https://www.documentation.ird.fr/hor/PAR00010934
%V 62
%W Horizon (IRD)
%X Objectives The aim of this study was to develop and validate a simple calculator to quantify the embolic risk (ER) at admission of patients with infective endocarditis. Background Early valve surgery reduces the incidence of embolism in high-risk patients with endocarditis, but the quantification of ER remains challenging. Methods From 1,022 consecutive patients presenting with definite diagnoses of infective endocarditis in a multicenter observational cohort study, 847 were randomized into derivation (n = 565) and validation (n = 282) samples. Clinical, microbiological, and echocardiographic data were collected at admission. The primary endpoint was symptomatic embolism that occurred during the 6-month period after the initiation of treatment. The prediction model was developed and validated accounting for competing risks. Results The 6-month incidence of embolism was similar in the development and validation samples (8.5% in the 2 samples). Six variables were associated with ER and were used to create the calculator: age, diabetes, atrial fibrillation, embolism before antibiotics, vegetation length, and Staphylococcus aureus infection. There was an excellent correlation between the predicted and observed ER in both the development and validation samples. The C-statistics for the development and validation samples were 0.72 and 0.65, respectively. Finally, a significantly higher cumulative incidence of embolic events was observed in patients with high predicted ER in both the development (p < 0.0001) and validation (p < 0.05) samples. Conclusions The risk for embolism during infective endocarditis can be quantified at admission using a simple and accurate calculator. It might be useful for facilitating therapeutic decisions.
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