Comparison of long-term mortality in patients with acute myocardial infarction associated with or without sepsis

Abstract

A B S T R A C TObjectives: Although the association between systemic infection and cardiovascular events has been identified, uncertainty remains regarding the incidence and prognosis of sepsis in acute myocardial infarction (AMI). The purpose of this research was to assess the impact of sepsis on survival after first AMI. Methods: This was a nationwide cohort study involving the analysis of data from the Taiwan National Health Insurance Research Database for the period 2000-2012, for patients with a primary diagnosis of first AMI. Among the 186 112 prospective patients, sepsis was diagnosed in 13 065 (7.0%). The propensity score matching technique was used to match 13 065 controls to the patients with sepsis and AMI with similar baseline characteristics. Cox proportional hazards regression models, including sepsis, percutaneous coronary intervention (PCI), and comorbidities, were performed to further evaluate the different influences on the mortality risk in patients hospitalized for first AMI. Results: Overall, the 12-year survival rate was lower in AMI patients with sepsis than in those without sepsis (log rank p-value <0.001); this was also shown in the different age and sex groups. The AMI patients with sepsis had a longer length of hospital stay than those without sepsis (32.5 days vs. 11.74 days, p < 0.001). In the Cox proportional hazards regression analysis, sepsis was an independent risk factor for mortality in patients after AMI (hazard ratio 1.78; 95% confidence interval 1.72-1.83). Interventional management with PCI or coronary artery bypass grafting improved survival in both the sepsis and non-sepsis patients after first AMI. Conclusions: In conclusion, sepsis significantly increased the mortality risk of patients after first AMI. PCI may improve the long-term survival of patients in comparison to those managed conservatively.

Post-Infectious Myocardial Infarction: Does Percutaneous Coronary Intervention Improve Outcomes? A Propensity Score-Matched Analysis

“…Among these patients, only 10% underwent an invasive (i.e., PCI and/or CABG) vs. conservative management strategy. In contrast with our results, revascularization was associated with half-reduced in-hospital mortality, after propensity-score matching [5]. Moreover, in the Taiwan Health insurance coding database, among patients with a first MI diagnosis, 7% had concurrent acute infection.…”

“…In the specific case of post-infectious MI, whether invasive strategies need to be performed remains to be investigated. This lack of evidence leads to a large heterogeneity in management of post-infectious MI, the revascularization (PCI or coronary artery bypass graft surgery (CABG)) rate ranging from 10% to 25% [5,6]. In this first large cohort of post-infectious MI hospitalized in coronary units, we aimed to evaluate the prognostic impact of PCI over the short and long term in patients with significant coronary stenosis (>50%) on coronary angiography.…”

“…Despite the emergence of post-infectious MI as a nosologic entity [ 2 , 3 ] associated with a worsening prognosis, optimal care for post-infectious MI is still unknown. Large retrospective studies from national health insurance data suggest a benefit of revascularization procedures after sepsis-related MI [ 4 , 5 ]. Percutaneous coronary intervention (PCI) is recommended in the emergency care of acute MI due to acute plaque incident (type 1 MI).…”

Comparison of Different Timing of Multivessel Intervention During Index-Hospitalization for Patients With Acute Myocardial Infarction

“…All enrolled patients were followed until death or December 31, 2012, whichever occurred first. The difference between the date of admission and the end date of NHI coverage offers a valid measure of survival ( 17 ). Furthermore, other adverse cardiovascular events, including hospitalizations due to recurrent myocardial infarction and stroke, were analyzed.…”

Mild hypothermia in rat with acute myocardial ischaemia‐reperfusion injury complicating severe sepsis

“…Patients with acute myocardial infarction (AMI) complicating sepsis are commonly witnessed in intensive care units. AMI complicated with severe sepsis can accelerate death and thus caused substantial mortality 1 . The sudden blockade of coronary arteries decreases the blood supply of involved myocardial regions and generally causes AMI.…”