心内膜炎に対する早期の手術により合併症を減らせる可能性がある（Abstract # 18470）

EASE：感染性心内膜炎の診断後、早期の手術により一部の合併症および再感染が軽減できる
EASE: Surgery soon after diagnosis of infective endocarditis eliminated some complications and repeat infections
感染性心内膜炎の診断後、早期の手術により脳卒中および再感染の発現が軽減できるとのlate-breaking researchの結果が2011年American Heart Association学会で発表された。韓国の研究者らは76人の患者（平均年齢48歳、男性69%）を、診断後48時間以内に手術を行う群と標準治療（抗生剤投与を行い、手術は重症例にのみ施行する群）とに無作為に割り付けた。患者のうち、標準治療群患者の77%が早期または待機的手術を診断後平均15日に受けた。早期手術群患者は診断の1日後に外科的修復術を施行された。手術6週後に、早期手術を受けた患者においては血管閉塞が認められなかったのに対し、標準治療群では脳卒中5件および動脈閉塞3件が発現した。院内死亡率は両群間で差はなく3%であった。治療6ヵ月後までに脳卒中および他の感染を発症した者は早期手術群では見られなかった。一方、標準治療を受けた患者の23%が合併症を発症した（塞栓イベント8件－うち5件が脳内、心内膜炎再発1件、および死亡2件）。死亡率は2群で同等であった：早期手術群3%および標準治療群5%。
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Surgery soon after diagnosis of infective endocarditis eliminated the incidence of strokes and repeat infections, researchers said in a late-breaking presentation at the American Heart Association's Scientific Sessions 2011.

Researchers report the first randomized study comparing standard treatment (antibiotics, with surgery only for severe cases) to antibiotics plus surgery soon after diagnosis.

Infective endocarditis is uncommon but serious. The condition is often fatal if left untreated, and effective antibiotic treatment is critical. Early surgery is generally reserved for patients in whom medicines didn't treat the problem completely or who have other complications.

"We found that early surgery - within 48 hours of diagnosis of infective endocarditis - is clinically feasible," said Duk-Hyun Kang, M.D, Ph.D., study author and professor of medicine in the Division of Cardiology at Asian Medical Center and the College of Medicine, University of Ulsan in Seoul, Korea.

"It can be an option to further improve clinical outcome in infective endocarditis, which is associated with considerable mortality and morbidity that has not improved significantly despite advances in medical and surgical treatment."

In the new study, researchers randomly assigned 76 patients to receive either surgery to remove infected tissue and repair damage within 48 hours of diagnosis or standard treatment, which includes antibiotics and surgery only in severe cases unresponsive to antibiotics or in those with other life-threatening complications. The participants were diagnosed with infective endocarditis and severe valve disease at two centers in Seoul between September 2006 and September 2011. Sixty-nine percent of the participants were male and average age was 48 years.

Among the patients, 77 percent in the standard therapy group had urgent or elective surgery an average of fifteen days after diagnosis. Early-surgery patients underwent surgical repair one day after diagnosis.

Researchers, analyzing the data on rate of death and arterial obstruction due to emboli by six weeks after surgery, found that:

  • Patients who underwent early surgery had no vascular obstruction, while five strokes and three arterial obstructions occurred among those on standard treatment.
  • The in-hospital death rate in the two groups was the same at 3 percent.
  • Six months after treatment, none of the early-surgery patients had developed stroke or another infection. In contrast, 23 percent of those who received standard therapy developed complications (eight embolic events ― five of these cerebral, one recurrence of endocarditis and two deaths).
  • Death rates were similar for the two groups: 3 percent for early surgery and 5 percent for standard treatment.

Following American Heart Association guidelines, patients in both groups received intravenous antibiotics for four to six weeks after diagnosis.

Co-authors are Yong-Jin Kim, M.D., Ph.D.; Sung-Han Kim, M.D., Ph.D.; Byung Joo Sun, M.D.; Dae-Hee Kim, M.D., Ph.D.; Sung-Cheol Yun, Ph.D.; Jong-Min Song, M.D., Ph.D.; Suk Jung Choo, M.D., Ph.D.; Cheol-Hyun Chung, M.D., Ph.D.; Jae-Kwan Song, M.D., Ph.D.; Jae-Won Lee, M.D., Ph.D.; and Dae-Won Sohn, M.D., Ph.D.