Comparison of Long-Term Mortality in Patients with Acute Myocardial Infarction Associated with or without Sepsis.
Int J Infect Dis. 2018 Nov 29;:
Authors: Liu ES, Chiang CH, Hung WT, Tang PL, Hung CC, Kuo SH, Liu CP, Chen YS, Mar GY, Huang WC
OBJECTIVES: Although the association between systemic infection and cardiovascular events has been identified, an uncertainty still exists in the incidence and prognosis of sepsis in acute myocardial infarction (AMI). The purpose of our research was to assess the impact of sepsis on survival after first AMI.
METHODS: This was a nationwide cohort study by analyzing the data from the Taiwan National Health Insurance Research Database between 2000 and 2012 for patients with a primary diagnosis of first AMI. Among the 186,112 prospective patients, sepsis was diagnosed in 13,065 (7.0%) patients. Propensity score matching technique was used to match 13,065 patients with sepsis and AMI with similar baseline characteristics. Cox proportional hazards regression models, including sepsis, percutaneous coronary intervention (PCI), and comorbidities, were performed to further evaluate the different influences on mortality risk of patients hospitalized for first AMI.
RESULTS: Overall, 12-year survival rate was lower in AMI patients with sepsis compared to those without sepsis (log rank P-value <0.001), which was also shown in different age or gender group). The AMI patients with sepsis had a longer length of hospital stay than those without sepsis (32.5days vs. 11.74 days, p <0.001). In cox proportional hazard regression analysis, sepsis was an independent risk factor for mortality in patients after AMI (hazard ratio, 1.78; 95% confidence interval, 1.72-1.83). Interventional management with PCI or coronary artery bypass grafting (CABG) improved survival in both sepsis and non-sepsis patients after first AMI.
CONCLUSIONS: In conclusion, sepsis significantly increased the mortality risk of patients after first AMI. PCI may improve the long-term survival of patients in comparison to those managed conservatively.
PMID: 30503653 [PubMed - as supplied by publisher]