Serious infections among unselected patients with ST-elevation myocardial infarction treated with contemporary primary percutaneous coronary intervention.
BACKGROUND
Contemporary studies assessing the frequency, characteristics, and outcomes of serious infections (SIs) in patients presenting a ST-elevation myocardial infarction are scarce.


METHODS
Prospective cohort of consecutive patients undergoing primary percutaneous coronary intervention (pPCI). Serious infection was defined as the presence of infection that prolonged hospitalization. Community-acquired infection (CAI) was defined by SI diagnosed in the first 72 hours of hospitalization, whereas hospital-acquired infections (HAI) were those diagnosed after 72 hours of hospital admission.


RESULTS
From December 2009 to November 2012, 1,486 patients were included in the analysis. Serious infection was present in 58 (3.9%) individuals; 30 (2%) patients had CAI and 28 (1.9%) patients had HAI. Respiratory tract infection was responsible for 82% of the SI. Patients with SI were older, had more comorbidities, and had worse angiographic results of the pPCI procedure when compared with those without SIs. After multivariable adjustment, SI was associated with an approximately 10-fold risk of 30-day death. Patients with CAI had more often a history of smoking, Killip III/IV on hospital admission, worse pPCI, and angiographic results than did patients with HAI. However, no differences were seen in 30-day major cardiovascular outcomes between patients with CAI and HAI.


CONCLUSIONS
In a contemporary cohort of unselected ST-elevation myocardial infarction patients representative of the daily practice, SI was uncommon but associated with worse pPCI results and high risk of mortality. The occurrences of CAI or HAI were similar, but CAI patients presented distinctly worse angiographic outcomes than did patients with HAI.
Instituto de Cardiologia/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, Brazil.
Pedro
P
Piccaro de Oliveira
Instituto de Cardiologia/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, Brazil.
Vinicius
V
Gonzales
Instituto de Cardiologia/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, Brazil.
Renato D
RD
Lopes
Instituto de Cardiologia/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, Brazil.
Marcia Moura
MM
Schmidt
Instituto de Cardiologia/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, Brazil.
Silvia
S
Garofallo
Instituto de Cardiologia/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, Brazil.
Rodrigo Pires Dos
RP
Santos
Instituto de Cardiologia/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, Brazil.
Luciana
L
Carrion
Instituto de Cardiologia/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, Brazil.
Carlos
C
Gottschall
Instituto de Cardiologia/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, Brazil. Electronic address: alesq@terra.com.br.
Alexandre S
AS
Quadros
D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology; D001424:Bacterial Infections / Q000453:epidemiology*; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000453:epidemiology*; D017023:Coronary Angiography; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000453:epidemiology; D012141:Respiratory Tract Infections / Q000453:epidemiology*; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D018805:Sepsis / Q000453:epidemiology*; D012907:Smoking / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000453:epidemiology; D013290:Streptococcal Infections / Q000453:epidemiology; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000453:epidemiology*