Epidemiology and Risk Factors of Mycotic Aneurysm in Patients With Infective Endocarditis and the Impact of its Rupture in Outcomes. Analysis of a National Prospective Cohort

Abstract

Background Several aspects of the occurrence and management of mycotic aneurism (MA) in patients with infective endocarditis (IE) have not been studied. Objectives To determine the incidence and factors associated with MA presence and rupture and to assess the evolution of those initially unruptured MA. Methods Prospective multicenter cohort including all patients with definite IE between January 2008 and December 2020. Results Out of 4,548 IE cases, 85 (1.9%) developed MA. 46 (54.1%) had intracranial MA and 39 (45.9%) extracranial MA. Rupture of MA occurred in 39 patients (45.9%). Patients with ruptured MA had higher 1-year mortality (HR 2.33, 95% CI 1.49-3.67). Of the 55 patients with initially unruptured MA, 9 (16.4%) presented rupture after a median of 3 days (IQR 1-7) after diagnosis, being more frequent in intracranial MA (32% vs 3.3%, p = 0.004). Of patients with initially unruptured MA, there was a trend to better outcomes among those who received early specific intervention, including lower follow-up rupture (7.1% vs 25.0%, p = 0.170), higher rate of aneurism resolution in control imaging (66.7% vs 31.3%, p = 0.087), lower MA-related mortality (7.1% vs 16.7%, p = 0.232), and lower MA-related sequalae (0% vs 27.8%, p = 0.045). Conclusions MA occurred in 2% of the patients with IE. Half of the MA present intracranial location. Their rupture is frequent and associated with poor prognosis. A significant proportion of initially unruptured aneurisms suffer from rupture during the first days, being more common in intracranial aneurisms. Early specific treatment could potentially lead to better outcomes.