Usefulness of APORTEI score beyond mortality predictor

Aportei score is a validated scale for predicting postoperative mortality in patients with infective endocarditis (IE). This score is mainly used to avoid futility in patients who would not benefit from surgery due to their high risk.

Our objective was to compare the occurrence of clinical complications (atrioventricular block (AVB), embolism, stroke) not included as items in the score between the different risk groups; in addition we compare the performance of cardiac surgery in each group. We registered mortality during hospitalization and CV mortality during follow-up.

For this purpose, a single-center prospective observational study was conducted in a tertiary hospital. We included patients admitted with a diagnosis of IE between 2016 and 2023 in a tertiary hospital, dividing them according to the Aportei score into low, medium, high and very high risk to compare the incidence of complications among them.

From 188 patients with a definitive diagnosis of infective endocarditis (men 72.5%; median age 69 years (RIQ 68)), they were distributed as follows: 27 at low risk, 28 at moderate risk, 53 at high risk and 80 at extreme risk.

Surgery was performed in 48.4% of the total; when comparing the performance of surgery between risk groups, no statistically significant differences were found.

Regarding stroke complications, a higher percentage was found in patients at high (37%) and very high risk (50%) (p=0.04), although no systemic embolism was found (p=0.5). Patients at higher Aportei risk had a statistically significant higher percentage of AVB (p=0.002). Mortality, regardless of whether surgery was performed, was higher in the groups of patients with higher scores, both cardiovascular (low risk 7.4% vs high risk 20.8%, p<0.001) and overall mortality during admission (low risk 7.2% vs high risk 15.1%, p<0.001).