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Published online: 2021-07-06
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Predictors and mid-term outcomes of nosocomial infection in ST-elevation myocardial infarction patients treated by primary angioplasty

Mariana Santos, Marta Oliveira, Susete Vieira, Rui Magalhães, Ricardo Costa, Bruno Brochado, Raquel Santos, João Silveira, Severo Torres, André Luz
DOI: 10.33963/KP.a2021.0058
·
Pubmed: 34231873

open access

Online first
Original article
Published online: 2021-07-06

Abstract

Background: Nosocomial infections (NI) are associated with high morbidity and mortality. Existing data on the impact of NI on patients with ST-elevation myocardial infarction (STEMI) is scarce.

Aims: Determine the incidence, predictors, and prognosis of NI in a contemporary series of STEMI-patients.

Methods: 1131 consecutive STEMI-patients treated by primary percutaneous coronary intervention from January 2008 to December 2017 were analyzed. Binary logistic regression and proportional hazard Cox models were used to identify predictors of NI and major adverse cardio-cerebrovascular events (MACCE) at 1-year follow-up, respectively.

Results: Of all patients, 126 (11.1%) were diagnosed with NI (>48 h from admission), mostly of respiratory (50.8%) and urinary (39.7%) tract origin. Insulin-treated diabetics were 3-fold more likely to develop NI. Other independent predictors were peripheral arterial disease, intra-aortic balloon pump insertion, age, lower systolic blood pressure, and higher peak creatine-kinase. Only pre-infarction angina was negatively related to NI. Age, peripheral arterial disease, femoral approach and larger infarct were related to MACCE at 1-year follow-up. NI in isolation was not independently related to MACCE (HR = 1.24; 95% CI, 0.80–1.94; P = 0.34). However, we found a significant interaction between NI and smoking (HR = 2.33; 95% CI, 1.03–5.24; Pinterc = 0.04).

Conclusion: Larger infarct size, hemodynamic instability, and co-morbidities were related to both NI and 1-year adverse events. Smokers who developed NI also had a higher 1-year risk of MACCE.

Abstract

Background: Nosocomial infections (NI) are associated with high morbidity and mortality. Existing data on the impact of NI on patients with ST-elevation myocardial infarction (STEMI) is scarce.

Aims: Determine the incidence, predictors, and prognosis of NI in a contemporary series of STEMI-patients.

Methods: 1131 consecutive STEMI-patients treated by primary percutaneous coronary intervention from January 2008 to December 2017 were analyzed. Binary logistic regression and proportional hazard Cox models were used to identify predictors of NI and major adverse cardio-cerebrovascular events (MACCE) at 1-year follow-up, respectively.

Results: Of all patients, 126 (11.1%) were diagnosed with NI (>48 h from admission), mostly of respiratory (50.8%) and urinary (39.7%) tract origin. Insulin-treated diabetics were 3-fold more likely to develop NI. Other independent predictors were peripheral arterial disease, intra-aortic balloon pump insertion, age, lower systolic blood pressure, and higher peak creatine-kinase. Only pre-infarction angina was negatively related to NI. Age, peripheral arterial disease, femoral approach and larger infarct were related to MACCE at 1-year follow-up. NI in isolation was not independently related to MACCE (HR = 1.24; 95% CI, 0.80–1.94; P = 0.34). However, we found a significant interaction between NI and smoking (HR = 2.33; 95% CI, 1.03–5.24; Pinterc = 0.04).

Conclusion: Larger infarct size, hemodynamic instability, and co-morbidities were related to both NI and 1-year adverse events. Smokers who developed NI also had a higher 1-year risk of MACCE.

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Keywords

cross infection, myocardial infarction, outcomes, smoking ST-elevation myocardial infarction

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About this article
Title

Predictors and mid-term outcomes of nosocomial infection in ST-elevation myocardial infarction patients treated by primary angioplasty

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2021-07-06

DOI

10.33963/KP.a2021.0058

Pubmed

34231873

Keywords

cross infection
myocardial infarction
outcomes
smoking ST-elevation myocardial infarction

Authors

Mariana Santos
Marta Oliveira
Susete Vieira
Rui Magalhães
Ricardo Costa
Bruno Brochado
Raquel Santos
João Silveira
Severo Torres
André Luz

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