Reduced valve replacement surgery and complication rate in Staphylococcus aureus endocarditis patients receiving acetyl-salicylic acid.

Abstract

OBJECTIVES:

To assess the influence of acetyl-salicylic acid (ASA) on clinical outcomes in Staphylococcus aureus infective endocarditis (SA-IE).

METHODS:

The International Collaboration on Endocarditis - Prospective Cohort Study database was used in this observational study. Multivariable analysis of the SA-IE cohort compared outcomes in patients with and without ASA use, adjusting for other predictive variables, including: age, diabetes, hemodialysis, cancer, pacemaker, intracardiac defibrillator and methicillin resistance.

RESULTS:

Data were analysed from 670 patients, 132 of whom were taking ASA at the time of SA-IE diagnosis. On multivariable analysis, ASA usage was associated with a significantly decreased overall rate of acute valve replacement surgery (OR 0.58 [95% CI 0.35-0.97]; p<0.04), particularly where valvular regurgitation, congestive heart failure or periannular abscess was the indication for such surgery (OR 0.46 [0.25-0.86]; p<0.02). There was no reduction in the overall rates of clinically apparent embolism with prior ASA usage, and no increase in hemorrhagic strokes in ASA-treated patients.

CONCLUSIONS:

In this multinational prospective observational cohort, recent ASA usage was associated with a reduced occurrence of acute valve replacement surgery in SA-IE patients. Future investigations should focus on ASA's prophylactic and therapeutic use in high-risk and newly diagnosed patients with SA bacteremia and SA-IE, respectively.

• Authors: Damon P Eisen, G Ralph Corey, Emma S McBryde, Vance G Fowler Jr, Jose M Miro, Chris H Cabell, Alan C Street, Marcelo Goulart Paiva, Adina Ionac, Ru-San Tan, Christophe Tribouilloy, Orathai Pachirat, Sandra Braun Jones, Natalia Chipigina, Christoph Naber, Angelo Pan, Veronica Ravasio, Rainer Gattringer, Vivian H Chu, Arnold S Bayer, ICE Investigators
• Journal: The Journal of infection (J Infect) Vol. 58 Issue 5 Pg. 332-8 (May 2009) ISSN: 1532-2742 [Electronic] England
• PMID: 19342103 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Platelet Aggregation Inhibitors
• Aspirin

Topics

• Aged
• Aspirin (therapeutic use)
• Cohort Studies
• Embolism (complications)
• Endocarditis, Bacterial (complications, therapy)
• Female
• Heart Failure (complications)
• Heart Valve Diseases (complications)
• Heart Valve Prosthesis Implantation
• Humans
• Male
• Middle Aged
• Platelet Aggregation Inhibitors (therapeutic use)
• Staphylococcal Infections (complications, drug therapy, microbiology)
• Staphylococcus aureus (drug effects)
• Stroke (complications)
• Treatment Outcome