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The size of the mass of bacteria, clot, and other material that characterizes infectious endocarditis does appear to matter for prognosis, a meta-analysis affirmed.

A vegetation larger than 10 mm was (95% CI 1.71-3.05, P<0.001) and 63% more often associated with mortality from any cause (95% CI 1.13-2.35, P=0.009) than were those smaller than 10 mm, Milind Desai, MD, of the Cleveland Clinic, and colleagues reported in JAMA Internal Medicine.

"Understanding the risk of embolization will allow clinicians to adequately risk stratify patients and will also help facilitate discussions regarding surgery in patients with a vegetation size greater than 10 mm," the researchers wrote.

The 10 mm cutoff is used in " as an important part of the recommendations for early surgery and also forms an integral part of protocols for large prospective clinical trials. However, the cutoff was based largely on observational data from small studies with significant potential for bias, the researchers noted.

"Clinicians often need to balance the risk of embolic events with the risk of surgery, and our analysis will benefit those discussions by providing quality evidence behind the odds of embolic events in patients with vegetation size greater than 10 mm."

The meta-analysis of 21 observational studies or trials included 6,646 unique patients with infective endocarditis, among whom there were 5,116 vegetations with measurements available. The findings were similar across subanalyses by age, sex, and type of valve involved, although the association with embolic outcomes strengthened over time.

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