55. Infective Endocarditis After Surgical or Transcatheter Aortic Valve Replacement

Abstract Background Infective endocarditis (IE) can complicate both surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) with significant morbidity and mortality despite differing pathogenesis. In the presence of limited data from direct comparison studies and recent expansion of TAVI to younger and lower- risk patients, we compared the incidence and timing of IE in TAVI versus SAVR. Methods Using data from the TriNetX electronic health records network, we identified (1) a cohort of patients who underwent TAVI between January 2016 and December 2020 (CPT procedure code 1021150) and (2) a propensity score-matched cohort of patients who underwent SAVR (CPT procedure codes 1035167 or 1029693, without any associated transcatheter procedure). We examined the incidence of IE (captured with ICD-10 codes I33, I38, or I39) over a 5-year follow up period and matched the cohorts for demographic data and clinically relevant background history. We used Kaplan-Meier estimates and Cox proportional hazards models to compare incidence between matched cohorts. Results We identified 6,302 patients with TAVI and 6,302 matched patients with SAVR. The baseline characteristics of the cohorts were well balanced, Table 1. All standardized mean differences were < 0.05, indicating adequate matching between cohorts. The Kaplan-Meier mortality at 5 years was 38.0% in the TAVI vs. 22.0% in the SAVR cohort (log-rank P < 0.001). There were 290 cases with IE in the TAVI and 604 cases in the SAVR cohort. The corresponding 5-year event rates were 10.0% vs. 16.9% (log-rank P < 0.001), respectively, Figure 1. The risk ratio of TAVI vs. SAVR related IE over the entire 5-year period was 0.48 (95%CI 0.42 — 0.55; P < 0.001). However, the relative risk for IE was non-proportional between groups over the 5-year period, with an early pronounced incidence among SAVR relative to TAVI patients and gradual convergence of the hazard rates over time, Figure 2. Figure 1. Cumulative 5-Year Incidence (Kaplan-Meier Estimates) of Infective Endocarditis Among Matched Transcatheter Aortic Valve Implantation (TAVI) vs. Surgical Aortic Valve Replacement (SAVR) Recipients Figure 2. Risk of Infective Endocarditis in SAVR vs. TAVI Recipients Over Time Conclusion In this comparative study, the risk for IE was lower among TAVI vs. SAVR recipients, primarily due to the higher risk of IE during the early post-SAVR period. With increasing uptake of TAVI procedures, a better understanding of the temporal occurrence and pathophysiology of IE and application of effective treatment strategies in these patients is required. Disclosures All Authors: No reported disclosures

Background. Infective endocarditis (IE) can complicate both surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) with significant morbidity and mortality despite differing pathogenesis. In the presence of limited data from direct comparison studies and recent expansion of TAVI to younger and lower-risk patients, we compared the incidence and timing of IE in TAVI versus SAVR.
Methods. Using data from the TriNetX electronic health records network, we identified (1) a cohort of patients who underwent TAVI between January 2016 and December 2020 (CPT procedure code 1021150) and (2) a propensity score-matched cohort of patients who underwent SAVR (CPT procedure codes 1035167 or 1029693, without any associated transcatheter procedure). We examined the incidence of IE (captured with ICD-10 codes I33, I38, or I39) over a 5-year follow up period and matched the cohorts for demographic data and clinically relevant background history. We used Kaplan-Meier estimates and Cox proportional hazards models to compare incidence between matched cohorts.
Results. We identified 6,302 patients with TAVI and 6,302 matched patients with SAVR. The baseline characteristics of the cohorts were well balanced, Table 1. All standardized mean differences were < 0.05, indicating adequate matching between cohorts. The Kaplan-Meier mortality at 5 years was 38.0% in the TAVI vs. 22.0% in the SAVR cohort (log-rank P < 0.001). There were 290 cases with IE in the TAVI and 604 cases in the SAVR cohort. The corresponding 5-year event rates were 10.0% vs. 16.9% (log-rank P < 0.001), respectively, Figure 1. The risk ratio of TAVI vs. SAVR related IE over the entire 5-year period was 0.48 (95%CI 0.42 -0.55; P < 0.001). However, the relative risk for IE was non-proportional between groups over the 5-year period, with an early pronounced incidence among SAVR relative to TAVI patients and gradual convergence of the hazard rates over time, Figure 2.

Conclusion.
In this comparative study, the risk for IE was lower among TAVI vs. SAVR recipients, primarily due to the higher risk of IE during the early post-SAVR period. With increasing uptake of TAVI procedures, a better understanding of the temporal occurrence and pathophysiology of IE and application of effective treatment strategies in these patients is required.
Disclosures. All Authors: No reported disclosures Background. Drug use-related infective endocarditis (IE) has nearly doubled in the past two decades in the United States, largely due to the current opioid crisis. Although there are robust data on surgical outcomes for people who use drugs (PWUD) vs. non-PWUD patients after an initial encounter for IE, long-term comparative data on post-IE outcomes are relatively sparse.

Long-Term Cardiovascular Outcomes After Drug-Related vs Non-Drug-Related Infective Endocarditis
Methods. Using data from the TriNetX electronic health records network, we identified (1) a cohort of patients 16 to 64 years old who had a first encounter for IE (captured with ICD-10 codes I33, I38, or I39) and history of drug use (captured with ICD-10 codes F11, F13-F16, F18, F19, O99.32, or T40) preceding the IE episode and (2) a propensity score-matched cohort of patients age 16-64 who had a first episode of IE and no documented drug use. We compared the post-IE incidence of (1) mortality; (2) ischemic stroke; (3) intracranial hemorrhage; (4) myocardial infarction; (5) heart failure; and (6) sudden cardiac death (cardiac arrest or ventricular fibrillation or tachycardia) between the 2 cohorts over a 5-year follow up period. We matched the cohorts for demographic data and clinically relevant medical history. We used Kaplan-Meier estimates and Cox models to compare incidence.
Results. We identified 6,578 PWUD patients and 6,578 matched non-PWUD patients 16-64 years old with a first episode of IE. The baseline characteristics are summarized in Table 1. Standardized mean differences of characteristics were generally < 0.1, indicating adequate matching. The 5-year Kaplan-Meier rates of outcomes of interest are summarized in Table 2. Mortality did not differ between cohorts. However, the incidence of ischemic stroke and intracranial hemorrhage was consistently higher among PWUD throughout the 5-year follow-up. Rates of myocardial infarction were also higher among PWUD; however, the difference was more pronounced later during follow-up. Rates of heart failure and sudden cardiac death did not differ.
Conclusion. Cardiovascular events after IE were common among both PWUD and non-PWUD patients over a 5-year follow-up period. However, rates of ischemic