Abstract 18110: Impact of Stroke Severity on Clinical Outcomes in Patients who had Infective Endocarditis With Cerebral Complications

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Background: The treatment strategy in active infective endocarditis (IE) with cerebral complications still remains unclear. We sought to analyze the association of the neurological deficit level with the clinical outcomes in IE patients with stroke. Methods and Results: Clinical data were retrospectively reviewed in 141 consecutive patients with active left-sided IE with cerebral complications. To evaluate the severity of stroke, the National Institute of Health Stroke Scale (NIHSS) was assessed in all patients on admission. There were 116 (82%) patients with cerebral infarction including 9 hemorrhagic infarctions and 57 (40%) patients with cerebral hemorrhage. We divided the patients according to NIHSS; severe stroke group (NIHSS>16: n=19) and non-severe stroke group (NIHSS≤16: n=122). Early surgery in the active phase (within 2 weeks after the initial diagnosis) was performed in 64 patients (6 severe stroke group and 58 non-severe stroke group), and the conventional treatment strategy was applied in 77 patients (13 severe stroke group and 64 non-severe stroke group). In the conventional treatment group, 37 patients (36 severe stroke group and 1 non-severe stroke group) underwent late surgical intervention. A mean follow-up period was 4.5 years. In-hospital death was significantly lower in non-severe stroke group (12% versus 53%, p<0.001). In addition, the freedom rate from IE-related death was significantly higher in patients with non-severe stroke than those with severe stroke (84±4 % versus 37±13 % at 5-year, p<0.001). Multivariate Cox proportional hazard analysis showed that NIHSS (HR=1.074; 95% CI 1.042-1.107: p<0.001), logistic EuroSCORE (HR=1.026; 95% CI 1.010-1.042: p=0.002), conventional treatment (HR=3.478; 95% CI 1.477-8.193: p=0.004), and aortic valve involvement (HR=3.091; 95% CI 1.460-6.546: p=0.003) were significantly associated with IE-related mortality (p<0.001). Conclusions: Severity of stroke was strongly associated with clinical outcomes in IE patients with cerebral complications. Therapeutic strategy for IE patients with stroke might have to be customized according to severity of neurological deficit.