The benefit/risk ratio to perform a systematic coronary angiogram (CA) before surgery for infective endocarditis (IE) is poorly reported and largely unknown. Recommendations are derived from studies on aortic stenosis management in stable patients where the prevalence of coronary artery disease may be much higher (vs. IE). Patients with IE usually do not present acute coronary issues and acute renal failure is frequent in such patients.

We assessed the benefit/risk ratio to perform a CA before surgery for IE.

We conducted a single-centre prospective registry including 272 patients with acute IE intended for surgery and compared patients who underwent a preoperative CA (n=160) to those who did not (n=112). A comprehensive meta-analysis was also conducted and included 551 patients: 342 who underwent a CA and 209 who did not.

In our registry, a combined bypass surgery (CABG) was performed in 17.3% of the patients with preoperative CA. At 2 years, the rate of the primary composite endpoint (all-cause death, new systemic embolism, stroke, new hemodialysis) was similar in the CA (37.5%) and no-CA (36.6%) groups. In-hospital and 2-year individual endpoints were all similar between groups. There were only 2 episodes of systemic embolism after CA and only one possibly related to a vegetation dislodgement. In the meta-analysis, a combined CABG was performed in 18.6% of the patients with preoperative CA. All-cause death was similar in the CA (19.1%) and no-CA groups (20.2%). Only 5 cases of systemic embolism possibly related to a vegetation dislodgement were reported. New hemodialysis was numerically more frequent in the CA group: 18.4% vs. 13.7% (P=0.179).

In daily practice, 2/3 of the patients with acute IE who required surgery have a preoperative CA leading to a combined CABG in 18% of the patients. Our results suggest that to perform a preoperative CA in this context is not associated with improved prognosis.