Corticosteroid Use and Incident Myocardial Infarction in Adults Hospitalized for Community-Acquired Pneumonia.
Ann Am Thorac Soc. 2018 Sep 06;:
Authors: Cangemi R, Falcone M, Taliani G, Calvieri C, Tiseo G, Romiti GF, Bertazzoni G, Farcomeni A, Violi F, SIXTUS study group
RATIONALE: Previous reports demonstrated that patients hospitalized for community-acquired pneumonia (CAP) present an increased risk of myocardial infarction (MI). Corticosteroid treatment lowers CAP morbidity and mortality, but it is not known if it affects in-hospital MI.
OBJECTIVES: The aim of the study was to investigate the potential interplay between corticosteroids treatment and in-hospital MI in CAP patients Methods: We retrospectively analyzed patients with CAP referred to the University-Hospital Policlinico Umberto I (Rome, Italy), consecutively recruited and prospectively followed-up until discharge. The primary outcome of this study was the occurrence of MI during hospitalization. Seven-hundred fifty-eight patients (493 males, 265 females; age: 71.7 ± 14.4 years) were included in the study: 241 (32%) were treated with systemic corticosteroids (methylprednisolone, betamethasone or prednisone) during in-hospital follow-up, whereas 517 patients were not treated with systemic corticosteroids.
RESULTS: During the follow-up, 62 patients (8.2%) (0.72 per 100 person/days, 95% CI: 0.55 to 0.92) had a MI. Patients treated with corticosteroids presented a lower incidence of MI compared to untreated ones (-0.48 per 100 person/days, 95%CI: -0.85 to -0.10). A Cox regression analysis showed that age, previous coronary heart disease and PaO2<60mmHg were positively associated to MI incidence, whereas corticosteroid therapy was negatively associated. Compared to patients not receiving corticosteroids, the propensity score-adjusted analysis confirmed that patients taking corticosteroids had a lower incidence of MI (HR: 0.461; 95% CI: 0.243 - 0.876, p=0.018).
CONCLUSIONS: This study shows that in-hospital corticosteroid treatment is associated with a lower incidence of MI within hospital-stay in CAP patients.
PMID: 30188173 [PubMed - as supplied by publisher]