EASE
Early Surgery versus Conventional Treatment in Infective Endocarditis
Doente / População Intervenção / Exposição Comparação Desfecho
In 76 patients with left-sided infective endocarditis, severe valve disease and large vegetations, early valve surgery within 48 hours reduced in-hospital death or embolic events at 6 weeks compared with conventional treatment with surgery only on clinical indication.
N
76
Desenho
Open-label RCT
Desfecho
Composite of in-hospital death and embolic events within 6 weeks
Relevância
2
Resultado3 % vs 23 % (HR 0.10; 95 % CI 0.01–0.82; p=0.03), driven entirely by fewer embolic events. All-cause mortality at 6 months 3 % vs 5 % (n.s.). 77 % of the conventional arm underwent surgery anyway.
Kang DH, Kim YJ, Kim SH, et al. N Engl J Med. 2012;366(26):2466-2473. 10.1056/NEJMoa1112843
Discussão e crítica
Very small, unblinded, and conducted in a young, largely streptococcal Korean population with excellent surgical results, so it does not transfer to elderly staphylococcal or prosthetic-valve disease. It is the only randomised evidence on the timing of surgery in endocarditis and supports operating early when vegetations are large and embolic risk high.