Acute myocardial infarction versus other cardiovascular events in community-acquired pneumonia

Abstract

The aim of the present study was to define the prevalence, characteristics, risk factors and impact on clinical outcomes of acute myocardial infarction (AMI) versus other cardiovascular events (CVEs) in patients with community-acquired pneumonia (CAP).This was an international, multicentre, observational, prospective study of CAP patients hospitalised in eight hospitals in Italy and Switzerland. Three groups were identified: those without CVEs, those with AMI and those with other CVEs.Among 905 patients, 21 (2.3%) patients experienced at least one AMI, while 107 (11.7%) patients experienced at least one other CVE. Patients with CAP and either AMI or other CVEs showed a higher severity of the disease than patients with CAP alone. Female sex, liver disease and the presence of severe sepsis were independent predictors for the occurrence of AMI, while female sex, age >65 years, neurological disease and the presence of pleural effusion predicted other CVEs. In-hospital mortality was significantly higher among those who experienced AMI in comparison to those experiencing other CVEs (43% versus 21%, p=0.039). The presence of AMI showed an adjusted odds ratio for in-hospital mortality of 3.57 (p=0.012) and for other CVEs of 2.63 (p=0.002).These findings on AMI versus other CVEs as complications of CAP may be important when planning interventional studies on cardioprotective medications.

Acute cardiac events in severe community‐acquired pneumonia: A multicenter study

“…Present study shows that occurrence of cardiac complications, defined as cardiac arrhythmia, congestive heart failure and myocardial infarction in CAP patients, is associated with an increase in hospital mortality rate by 15%. This increase is higher than some previous studies, but it is lower than others …”

“…Information on risk factors for acute cardiac events in patients with CAP is variable. The presence of age > 65 years, female sex, tachycardia, septic shock, severe sepsis, diabetes, hyperlipidemia, chronic kidney disease, need for mechanical ventilation, multilobar pneumonia, Staphylococcus aureus , Klebsiella pneumoniae or pneumococcal pneumonia, nursing home residence, history of cardiac disease, tachypnea, blood pH < 7.35, BUN > 30 mg/dl, serum sodium < 130 mmol/L, pleural effusion, pneumonia severity were factors independently associated with the diagnosis of cardiac complications . In the present study, age, the presence of hypoalbuminemia or pleural effusion, use of diuretic, haloperidol or vasopressor were identified by multivariate analysis as independent predictors of acute cardiac events.…”

“…These events include heart failure, arrhythmia and myocardial infarction. Recent studies show that 2% to 32% adults admitted to hospital with CAP develop at least one acute cardiac complication during their hospital stay . The most prevalent complication is arrhythmia as reported in these different cohorts.…”

Cardiovascular Events after Community-Acquired Pneumonia: A Global Perspective with Systematic Review and Meta-Analysis of Observational Studies

“…Twelve studies provided data on inpatients [31,39,40,[46][47][48]54,56,58,59,64], four on low-risk inpatients [45,55,57,61] and five on high-risk inpatients [35,55,57,61,63]. Pooled event rates were 13.9% (95% confidence interval (CI) 9.6-18.9), 5.7% (95% CI 3.1-9.0) and 15.6% (95% CI 6.1-28.4), respectively ( Figure 2).…”

Estimated Cardiac Risk Associated With Macrolides and Fluoroquinolones Decreases Substantially When Adjusting for Patient Characteristics and Comorbidities

“…For example, pneumonia, the reason for many macrolide and fluoroquinolone prescriptions, can cause arrhythmias, 18 and many patients hospitalized for pneumonia also have other cardiac events. [19][20][21] Furthermore, antimicrobials are frequently inappropriately prescribed for influenza and other respiratory tract viruses, 22 and influenza is thought to be a risk factor for AMIs 16,23 as well as chronic obstructive pulmonary disease exacerbations, 16 which can, in turn, lead to cardiac events. 24 Indeed, in our unadjusted analysis, both doxycycline and amoxicillin clavulanate, 2 drugs that have not been associated with arrhythmias, were associated with increased risk for cardiac events.…”