Long-term outcome in patients with prosthetic valve endocarditis: results from a single center in Turkey

OBJECTIVE

Prosthetic valve endocarditis (PVE) is associated with increased mortality and morbidity. Information regarding the long-term outcome of PVE is scarce in Turkey. The aim of this study was to evaluate long-term mortality rates of PVE and identify predictors of mortality in these patients.

METHODS

From January 2008 through August 2013, 44 patients (25 male, 19 female; mean age 49.3±12.1 years) who received a definitive diagnosis of PVE enrolled in the study.Median follow-up period was 23 months. Survival status was assessed for each patient by reviewing charts and making contact by phone. Cox regression analysis was used to evaluate outcome predictors.

RESULTS

The mitral valve was the most commonly affected valve and Staphylococcus aureus the most prevalent microorganism. Fourteen patients (32%) underwent surgery, 7 of whom underwent early surgery. Overall mortality and in-hospital mortality rates were 39% (n=17) and 25% (n=11), respectively. In multivariate analysis, NYHA classification >2 (hazard ratio [HR] 3.7; 95% confidence interval [CI], 1.16-11.8; p=0.03), early-onset PVE (HR 4.23; 95% CI, 1.1-16.42; p=0.04), vegetation size ≥10 mm (HR 3.94; 95% CI, 1.1-14.75; p=0.04), and heart failure (HR 4.18; 95% CI, 1.36-12.8; p=0.01) were found to be independent predictors of mortality.

CONCLUSION

Our findings suggest that PVE is associated with increased long-term mortality rates. Poor functional status, early-onset PVE, heart failure, and vegetation size are independent predictors of survival in patients with PVE.

Management of cardiac device infections according to current data

The use of implantable devices in management of cardiac diseases is increasing as a result of improvements in technology of permanent pacemaker and implantable cardioverter defibrillators. Device related infections are also rising accordingly and have become an important clinical problem. Accurate diagnosis and optimal management of these infections is challenging, necessitating complete removal of the device and prolonged antibiotic therapy. In this regard, a multidisciplinary approach is required with the essential support of microbiology and imaging modalities. This paper highlights the current literature on the pathogenesis, risk factors, diagnosis and management of device related infections.

Factors influencing the use of ambulance among patients with acute coronary syndrome: results of two centers in Turkey

OBJECTIVE

In this study, we aimed to identify the factors influencing the use of ambulance among patients admitted to two Turkish hospitals with acute coronary syndrome (ACS).

METHODS

Overall, 330 with a mean age of 55±13 years, hospitalized patients with ACS at 2 different hospitals were included in this prospective cohort study. The factors influencing the use of ambulance hospital were investigated through a questionnaire. The comparisons were made between two groups regarding use of ambulance. The predictors of the use of ambulance were determined using multiple logistic regression analysis.

RESULTS

Despite the high rate of knowing the emergency service number of "112", of the 330 patents, only 96 (29%) used ambulance. Ambulance users had shorter arrival duration with median of 60 min vs 120 min (p=0.03). Presenting with ST elevation myocardial infarction (OR=3.127, 95% CI: 1.555-6.2877, p<0.001), severity of chest pain (OR=2.665, 95% CI: 1.938-3.665, p<0.001), presence of accompanying symptoms such as dyspnea (OR= 5.510, 95% CI: 2.614-11.614, p<0.001), dizziness (OR=4.172, 95% CI: 1.901-9.154, p<0.001) and vomiting (OR=3.756, 95% CI: 1.521-9.272, p=0.004), knowledge of cardiac risk factors (OR=10.512, 95% CI: 4.497-24.572, p<0.001) or chest pain related to heart attack and the importance of quickly seeking for medical care by calling ambulance (OR= 4.184, 95% CI: 2.528-6.926, p<0.001) are the factors associated with ambulance use.

CONCLUSION

Using ambulance was in a very low rate among our study patients with ACS. Severity of symptoms, type of ACS and knowledge are seemed to be related with increased ambulance use. Informative health educational programs can be organized to achieve a behavioral change in using of ambulance.