From the Guidelines
Prior acute coronary syndrome is not independently associated with an increased risk of embolization in Infective Endocarditis. In infective endocarditis, the factors independently associated with an increased risk of embolization include S. aureus infection, mobile vegetations greater than 10mm in diameter, and infection involving the mitral valve anterior leaflet, as confirmed by the American Heart Association in their 2015 scientific statement for healthcare professionals 1. The highest incidence of embolic complications is seen with mitral valve IE, particularly with anterior mitral leaflet involvement, and with IE caused by S aureus, Candida, and HACEK organisms 1. Some key points to consider in the management of infective endocarditis and the risk of embolization include:
- The role of vegetation size in predicting embolic risk, with larger vegetations (>10mm) having a higher risk of embolization, especially in the setting of mitral valve endocarditis 1
- The importance of early surgical intervention in certain cases, such as those with large vegetations, prosthetic valve endocarditis, or native valve endocarditis caused by virulent organisms like S. aureus 1
- The need for careful consideration of the risks and benefits of surgery, including the potential for reducing embolic events, but also the risks of valve replacement and lifelong anticoagulation 1
- The use of echocardiography, particularly transesophageal echocardiography (TEE), in assessing vegetation size and predicting embolic risk, although the relationship between echocardiography and embolic risk can be complex and influenced by various factors 1. Overall, understanding the risk factors for embolization in infective endocarditis is crucial for clinicians to identify patients at higher risk for embolic complications and to provide appropriate management, including earlier surgical intervention or more aggressive medical therapy, to reduce the risk of morbidity and mortality.
From the Research
Factors Not Independently Associated with Increased Risk of Embolization
- Prior Acute Coronary Syndrome (ACS) is not independently associated with an increased risk of embolization in Infective Endocarditis 2, 3, 4, 5, 6
Factors Associated with Increased Risk of Embolization
- Staphylococcus aureus (S. aureus) Infective Endocarditis (IE) is associated with an increased risk of embolization 3, 5
- Mobile vegetations greater than 10 millimeters in diameter are associated with an increased risk of embolization 2, 3, 5
- Infection involving the mitral valve anterior leaflet is associated with an increased risk of embolization 4, 6