title: Obstructive coronary artery disease in patients hospitalized for severe sepsis or septic shock with concomitant acute myocardial infarction.
abstract: OBJECTIVE
  It is difficult to differentiate type 1 acute myocardial infarction (AMI) with obstructive coronary artery disease (OCAD) from type 2 AMI in patients admitted for severe sepsis. The aims of this study were to assess the risk factors and prognosis of OCAD in patients admitted to the intensive care unit for severe sepsis with concomitant AMI.
  
  
  METHODS
  This is a single-center retrospective cohort study including all consecutive patients who were hospitalized for severe sepsis or septic shock between March 2006 and September 2014 and who underwent coronary angiography in the intensive care unit to identify AMI.
  
  
  RESULTS
  Overall, 78 (5.5%) of 1418 patients hospitalized for severe sepsis underwent coronary angiography to identify concomitant AMI. Thirty-two patients (41%) had OCAD. Following multivariate analysis, the risk factors of OCAD were peripheral vascular disease (odds ratio [OR] =5.7; 95% confidence interval [CI], 1.1-30.4; P = .042) and at least 2 cardiovascular risk factors (OR = 6.7; 95% CI, 1.9-23.8; P = .003). Obstructive coronary artery disease was associated with a significant mortality increase at 60 days (OR = 8.1; 95% CI, 1.9-30.2; P = .004).
  
  
  CONCLUSIONS
  Obstructive coronary artery disease is a poor prognosis factor in patients hospitalized for severe sepsis with concomitant AMI. In this setting, medical treatment should be considered for patients with peripheral vascular disease or with at least 2 cardiovascular risk factors; the need to perform coronary angiography should be considered carefully.
authors.affiliation: Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France. Electronic address: nicolas.allou@hotmail.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Allou
authors.affiliation: Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France. Electronic address: caroline.brulliard@chu-reunion.fr.
authors.forename: Caroline
authors.initials: C
authors.lastname: Brulliard
authors.affiliation: Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France. Electronic address: dorothee.valance@chu-reunion.fr.
authors.forename: Dorothée
authors.initials: D
authors.lastname: Valance
authors.affiliation: Cardiologie, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France. Electronic address: jean-baptiste.esteve@chu-reunion.fr.
authors.forename: Jean Baptiste
authors.initials: JB
authors.lastname: Esteve
authors.affiliation: Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France. Electronic address: olivier.martinet@chu-reunion.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Martinet
authors.affiliation: Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France. Electronic address: laure.corradi@chu-reunion.fr.
authors.forename: Laure
authors.initials: L
authors.lastname: Corradi
authors.affiliation: Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France. Electronic address: cordiercharlotte@hotmail.fr.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Cordier
authors.affiliation: Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France. Electronic address: bruno.bouchet@chu-reunion.fr.
authors.forename: Bruno
authors.initials: B
authors.lastname: Bouchet
authors.affiliation: Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France. Electronic address: allyn.jer@gmail.com.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Allyn
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000209:etiology* / Q000401:mortality; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000150:complications* / Q000401:mortality / Q000628:therapy
keywords: Acute myocardial infarction; Cardiovascular risk factors; Obstructive coronary artery disease; Septic shock; Severe sepsis