Serious infection after acute myocardial infarction: incidence, clinical features, and outcomes

Adriano A M Truffa; Christopher B Granger; Kyle R White; L Kristin Newby; Rajendra H Mehta; Judith S Hochman; Manesh R Patel; Karen S Pieper; Hussein R Al-Khalidi; Paul W Armstrong; Renato D Lopes

doi:10.1016/j.jcin.2012.03.018

Serious infection after acute myocardial infarction: incidence, clinical features, and outcomes

JACC Cardiovasc Interv. 2012 Jul;5(7):769-76. doi: 10.1016/j.jcin.2012.03.018.

Authors

Adriano A M Truffa¹, Christopher B Granger, Kyle R White, L Kristin Newby, Rajendra H Mehta, Judith S Hochman, Manesh R Patel, Karen S Pieper, Hussein R Al-Khalidi, Paul W Armstrong, Renato D Lopes

Affiliation

¹ Duke Clinical Research Institute and the Department of Medicine, Duke University Medical Center, 2400 Pratt Street, Durham, NC 27705, USA.

Abstract

Objectives: The aim of this study was to address the knowledge gap using the APEX-AMI (Assessment of Pexelizumab in Acute Myocardial Infarction) trial database. We also assessed the association between serious infections and 90-day death or death/myocardial infarction (MI).

Background: Little is known about the incidence, location, etiological organisms, and outcomes of infection in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention.

Methods: We analyzed data from 5,745 STEMI patients enrolled in the APEX-AMI trial. Detailed information on infection was collected for all patients. We described characteristics of patients according to infection and details of infection. Cox proportional hazards models were used to assess 90-day outcomes among patients with and without infections after adjusting for associated clinical variables and with infection as a time-dependent covariate.

Results: Overall, 138 patients developed a serious infection (2.4%), most of whom presented with a single-site infection. The median (25th, 75th percentile) time until diagnosis of infection was 3 (1, 6) days. The most commonly identified organism was Staphylococcus aureus, and the main location of infection was the bloodstream. These patients had more comorbidities and lower procedural success at index percutaneous coronary intervention than those without infections. Serious infection was associated with significantly higher rates of 90-day death (adjusted hazard ratio: 5.6; 95% confidence interval: 3.8 to 8.4) and death or MI (adjusted hazard ratio: 4.9; 95% confidence interval: 3.4 to 7.1).

Conclusions: Infections complicating the course of patients with STEMI were uncommon but associated with markedly worse 90-day clinical outcomes. Mechanisms for early identification of these high-risk patients as well as design of strategies to reduce their risk of infection are warranted.

Trial registration: ClinicalTrials.gov NCT00091637.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Angioplasty, Balloon, Coronary / adverse effects*
Bacterial Infections / etiology*
Bacterial Infections / microbiology
Databases, Factual
Female
Humans
Incidence
Male
Middle Aged
Myocardial Infarction / complications*
Myocardial Infarction / mortality
Myocardial Infarction / therapy
Proportional Hazards Models
Risk Assessment
Risk Factors
Staphylococcus aureus
Treatment Outcome
United States

Associated data

ClinicalTrials.gov/NCT00091637

Grants and funding

T32 HL079896/HL/NHLBI NIH HHS/United States