Impact of concomitant respiratory infections in the management and outcomes acute myocardial infarction-cardiogenic shock

Abstract

Objective To evaluate the prevalence and impact of respiratory infections in cardiogenic shock complicating acute myocardial infarction (AMI-CS). Methods Using the National Inpatient Sample (2000–2017), this study identified adult (≥18 years) admitted with AMI-CS complicated by respiratory infections. Outcomes of interest included in-hospital mortality of AMI-CS admissions with and without respiratory infections, hospitalization costs, hospital length of stay, and discharge disposition. Temporal trends of prevalence, in-hospital mortality and cardiac procedures were evaluated. Results Among 557,974 AMI-CS admissions, concomitant respiratory infections were identified in 84,684 (15.2%). Temporal trends revealed a relatively stable trend in prevalence of respiratory infections over the 18-year period. Admissions with respiratory infections were on average older, less likely to be female, with greater comorbidity, had significantly higher rates of NSTEMI presentation, and acute non-cardiac organ failure compared to those without respiratory infections (all p < 0.001). These admissions received lower rates of coronary angiography (66.8% vs 69.4%, p < 0.001) and percutaneous coronary interventions (44.8% vs 49.5%, p < 0.001), with higher rates of mechanical circulatory support, pulmonary artery catheterization, and invasive mechanical ventilation compared to AMI-CS admissions without respiratory infections (all p < 0.001). The in-hospital mortality was lower among AMI-CS admissions with respiratory infections (31.6% vs 38.4%, adjusted OR 0.58 [95% CI 0.57–0.59], p < 0.001). Admissions with respiratory infections had longer lengths of hospital stay (12 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 vs 6 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 days, p < 0.001), higher hospitalization costs and less frequent discharges to home (27.1% vs 44.7%, p < 0.001). Conclusions Respiratory infections in AMI-CS admissions were associated with higher resource utilization but lower in-hospital mortality.

A Retrospective Study Assessing the Effect of Infections in Myocardial Infarction Patients: Mortality and Complications

“…But in contrast to the earlier literature ndings and the ones in our study, Parenica et al (2017) found no signi cant difference in mortality between infected and non-infected acute MI patients admitted with cardiogenic shock [30]. In fact, Patlolla et al (2021) in their recent published article observed lower in-hospital mortality rate in acute myocardial infarction and cardiogenic shock patient complicated by respiratory infection compared to those with no infections, as well as lower utilization of coronary angiography and PCI which was attributed to higher rates NSTEMI-CS and lower rates of STEMI-CS in admissions with respiratory infections compared to those without [31].…”

“…A total of 100 patients developed sputum infection, and the duration of stay for these patients were on average 15.3 days, which is more than double the duration spent by MI patients without any infections (6 days). These results were in line with those found in previous studies demonstrating that indeed MI admissions with concomitant respiratory infection presenting with in uenza [29] or with cardiogenic shock [31] have longer hospital stay and higher cost compared to those with no respiratory infections. Duration of hospital stay for patient with concomitant respiratory infection was slightly lower than those with bloodstream infections but higher than those with wound infections (45 patients averaging 12.0 days) and urine infections (113 patients averaging 11.7 days).…”