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Original research article
Coronary events complicating infective endocarditis
  1. Virginie Roux1,
  2. Erwan Salaun1,2,
  3. Christophe Tribouilloy3,
  4. Sandrine Hubert1,2,
  5. Yohann Bohbot3,
  6. Jean-Paul Casalta2,
  7. Pierre-Antoine Barral4,
  8. Dan Rusinaru3,
  9. Frederique Gouriet2,
  10. Cecile Lavoute1,2,
  11. Julie Haentjens1,
  12. Mathieu Di Biscegli4,
  13. Aurelie Dehaene4,
  14. Sebastien Renard1,
  15. Anne-Claire Casalta1,
  16. Julie Pradier1,
  17. Jean-Francois Avierinos1,
  18. Alberto Riberi1,2,
  19. Marc Lambert1,
  20. Frederic Collart1,
  21. Alexis Jacquier4,
  22. Franck Thuny5,6,
  23. Laurence Camoin-Jau2,7,
  24. Hubert Lepidi2,8,
  25. Didier Raoult2,
  26. Gilbert Habib1,2
  1. 1 Aix-Marseille Université, Marseille, France
  2. 2 URMITE, Aix Marseille Université. UM63, CNRS 7278, IRD 198, INSERM 1095- IHU - 13005 Marseille, Marseille, France
  3. 3 Department of Cardiology, University Hospital Amiens, Amiens, France and INSERM U-1088, Jules Verne University of Picardie, Amiens, France, Jules Verne University of Picardie, Amiens, France
  4. 4 Hopitaux de la Timone, Department of Radiology and Cardiovascular Imaging, Aix-Marseille Université, CNRS, CRMBM UMR 7339, 13385 Marseille, France, Marseille, France
  5. 5 Aix Marseille Univ, Assistance Publique Hopitaux de Marseille (AP HM), Department of Cardiology, Marseille, France
  6. 6 Mediterranean Association for Research and Studies in Cardiology (Mars Cardio), Marseille, France
  7. 7 Service d’Hématologie Biologique CHU Timone Marseille, France
  8. 8 Laboratoire d’Anatomie Pathologique CHU Timone Marseille, France
  1. Correspondence to Dr Gilbert Habib, Cardiology Department, Hôpital La Timone Boulevard Jean Moulin, 13005 Marseille, France; gilbert.habib{at}


Objective Acute coronary syndromes (ACS) are a rare complication of infective endocarditis (IE). Only case reports and small studies have been published to date. We report the largest series of ACS in IE. The aim of our study was to describe the incidence and mechanisms of ACS associated with IE, to assess their prognostic impact and to describe their management.

Methods In a bicentre prospective observational cohort study, all patients with a definite diagnosis of IE were prospectively included. The incidence, mechanism and prognosis of patients with ACS were studied.

Results Among 1210 consecutive patients with definite IE, 26 patients (2.2%) developed an ACS. Twenty-three patients (88%) had a coronary embolism. Two patients had coronary compression by an abscess or a pseudoaneurysm and one patient had an obstruction of his bioprosthesis and left coronary ostium by a large vegetation. Nineteen (73%) patients with ACS developed heart failure and this complication was 2.5 times more frequent than in patients without ACS (p<0.0001). In the ACS population, mortality rate was twice than the population without ACS.

Conclusions ACS is a rare complication of IE but is associated with an increased risk of heart failure and high mortality rate.

  • acute coronary syndromes
  • endocarditis

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  • Contributors CT, SH, J-PC, FC, AJ, FT, DR and GH planned the study. VR, ES, YB, P-AB, DR, FG, CL, JH, MDB, AD, SR, A-CC, JP, J-FA, AR and ML conducted the study. ES, CT, J-FA, FC, LC-J, HL and GH wrote and reviewed the paper.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.