- They see a lot of severe endocarditis in Korea! -they screened an average of 2 patients/month. (But the population of S Korea is about the
same as the UK and the study centres are the 2 biggest hospitals).
- Was this study doomed to failure in showing a mortality reduction? - does their power calculation look for too big a difference?
- Right sided vegitations were excluded. I'm not sure why, and I think
embolization to the lung is still important.
- They had a remarkable consent rate (95%) - maybe this says something about the Korean culture?
- I'm not so sure about CT with contrast looking for embolisation at
randomisation -these patients are at risk of renal failure and the investigation is not to my mind clinically justified.
- The surgeons seemed fairly passive in all this - there is no mention of
intention to treat but all those randomised to surgery got it.
- Finally, I wondered if this was a study of the obvious with regard to
embolisation - remove the source of the emboli, no emboli and vice
This Korean RCT looks at whether in complicated endocarditis (vegitations bigger than 10mm with severe valvular dysfunction), early surgery reduces mortality and embolisation.
Some of the thoughts I had on reading it included:
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