title: Serious infection after acute myocardial infarction: incidence, clinical features, and outcomes.
abstract: OBJECTIVE
  The aim of this study was to address the knowledge gap using the APEX-AMI (Assessment of Pexelizumab in Acute Myocardial Infarction) trial database. We also assessed the association between serious infections and 90-day death or death/myocardial infarction (MI).
  
  
  BACKGROUND
  Little is known about the incidence, location, etiological organisms, and outcomes of infection in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention.
  
  
  METHODS
  We analyzed data from 5,745 STEMI patients enrolled in the APEX-AMI trial. Detailed information on infection was collected for all patients. We described characteristics of patients according to infection and details of infection. Cox proportional hazards models were used to assess 90-day outcomes among patients with and without infections after adjusting for associated clinical variables and with infection as a time-dependent covariate.
  
  
  RESULTS
  Overall, 138 patients developed a serious infection (2.4%), most of whom presented with a single-site infection. The median (25th, 75th percentile) time until diagnosis of infection was 3 (1, 6) days. The most commonly identified organism was Staphylococcus aureus, and the main location of infection was the bloodstream. These patients had more comorbidities and lower procedural success at index percutaneous coronary intervention than those without infections. Serious infection was associated with significantly higher rates of 90-day death (adjusted hazard ratio: 5.6; 95% confidence interval: 3.8 to 8.4) and death or MI (adjusted hazard ratio: 4.9; 95% confidence interval: 3.4 to 7.1).
  
  
  CONCLUSIONS
  Infections complicating the course of patients with STEMI were uncommon but associated with markedly worse 90-day clinical outcomes. Mechanisms for early identification of these high-risk patients as well as design of strategies to reduce their risk of infection are warranted.
authors: Duke Clinical Research Institute and the Department of Medicine, Duke University Medical Center, 2400 Pratt Street, Durham, NC 27705, USA.
authors: Adriano A M
authors: AA
authors: Truffa
authors: Christopher B
authors: CB
authors: Granger
authors: Kyle R
authors: KR
authors: White
authors: L Kristin
authors: LK
authors: Newby
authors: Rajendra H
authors: RH
authors: Mehta
authors: Judith S
authors: JS
authors: Hochman
authors: Manesh R
authors: MR
authors: Patel
authors: Karen S
authors: KS
authors: Pieper
authors: Hussein R
authors: HR
authors: Al-Khalidi
authors: Paul W
authors: PW
authors: Armstrong
authors: Renato D
authors: RD
authors: Lopes
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D001424:Bacterial Infections / Q000209:etiology* / Q000382:microbiology; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000628:therapy; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013211:Staphylococcus aureus; D016896:Treatment Outcome; D014481:United States