Acute bacterial pneumonia is associated with the occurrence of acute coronary syndromes.
A link between acute infections and the development of acute coronary syndromes (ACS) has been proposed. We used retrospective cohort and self-controlled case series analyses to define the closeness of the association between acute bacterial pneumonia due to Streptococcus pneumoniae or Haemophilus influenzae and ACS. For the retrospective cohort analysis we included a control group of patients with admission diagnoses other than pneumonia or ACS. For the self-controlled case series analysis, we made within-person comparisons of the risk for ACS during the 15 days after admission for pneumonia with that of 365 days before and after that event. In 206 pneumonia patients (144 S. pneumoniae, 62 H. influenzae) we identified 22 (10.7%) cases of ACS, which compared to 6 (1.5%) among 395 controls resulted in an odds ratio (OR) of 7.8 (95% confidence interval [CI], 3.1-19.4). With multivariate logistic regression analysis, the OR for ACS in the pneumonia group remained elevated (OR, 8.5; 95% CI, 3.4-22.2). By the self-controlled case series method, the risk of ACS remarkably increased during the first 15 days after the diagnosis of pneumonia (incidence rate ratio, 47.6; 95% CI, 24.5-92.5). The characteristics and strength of these associations suggest a causal role for the acute infection in this relationship.
From the Departments of Medicine (VFCM, JS, TPG, BB, MM, DT, DMM) and Molecular Virology and Microbiology (DT, DMM), Baylor College of Medicine, Houston; the Medical Care Line, Infectious Disease Section (AMR, DMM) and Cardiology Section (BB), Michael E. DeBakey Veterans Affairs Medical Center, Houston; and the Texas Heart Institute (MM), University of Texas Health Science Center, Houston, Texas.
Vicente F
VF
Corrales-Medina
Jose
J
Serpa
Adriana M
AM
Rueda
Thomas P
TP
Giordano
Biykem
B
Bozkurt
Mohammad
M
Madjid
David
D
Tweardy
Daniel M
DM
Musher
D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000382:microbiology*; D000368:Aged; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000150:complications / Q000382:microbiology; D016001:Confidence Intervals; D005260:Female; D006192:Haemophilus Infections / Q000150:complications* / Q000382:microbiology; D006193:Haemophilus influenzae / Q000302:isolation & purification*; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D018410:Pneumonia, Bacterial / Q000150:complications* / Q000382:microbiology; D011018:Pneumonia, Pneumococcal / Q000150:complications / Q000382:microbiology; D012189:Retrospective Studies; D013296:Streptococcus pneumoniae / Q000276:immunology*; D013781:Texas / Q000453:epidemiology