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Infections linked to significantly worse outcomes in STEMI patients
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Although rare, serious infections were associated with fivefold higher rates of 90-day mortality and death or MI in patients with ST-segment elevation MI who underwent PCI.
“Little is known about the incidence, location, demographic data, and etiological organisms of serious infection in patients with acute MI, particularly STEMI, who are treated with primary PCI in the contemporary era,” researchers wrote.
To close this knowledge gap, Adriano A.M. Truffa, MD, of Duke University Medical Center, and colleagues analyzed data from STEMI patients in the APEX-AMI trial.
Of the 5,745 patients included in the study, only 138 (2.4%) developed a serious infection, with a median time to diagnosis of 3 days. Staphylococcus aureus was the most commonly identified organism and the main location of infection was the bloodstream. Patients with infections were more likely to have a history of inflammatory disease, chronic obstructive pulmonary disease or worse prognostic markers, such as higher creatinine level at baseline, more advanced Killip class, higher heart rate and larger infarcts. They also had lower procedural success at index PCI.
Results associated serious infection with higher rates of 90-day death (adjusted HR=5.6; 95% CI, 3.9-8.4) and death or MI (adjusted HR=4.9; 95% CI, 3.4-7.1).
“Infections complicating the course of patients with STEMI were uncommon but associated with markedly worse 90-day clinical outcomes,” the researchers wrote. “Mechanisms for early identification of these high-risk patients as well as design of strategies to reduce their risk of infection are warranted.”
Disclosure: The APEX-AMI trial was jointly funded by Procter & Gamble Pharmaceuticals and Alexion Pharmaceuticals. This analysis was supported by the Duke Clinical Research Institute. See study for a full list of disclosures.
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