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

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Truffa, AAM; Granger, CB; White, KR; Newby, LK; Mehta, RH; Hochman, JS; Patel, MR; Pieper, KS; Al-Khalidi, HR; Armstrong, PW; Lopes, RD

Published Date

  • July 2012

Published In

Volume / Issue

  • 5 / 7

Start / End Page

  • 769 - 776

PubMed ID

  • 22814783

Electronic International Standard Serial Number (EISSN)

  • 1876-7605

Digital Object Identifier (DOI)

  • 10.1016/j.jcin.2012.03.018

Language

  • eng

Conference Location

  • United States