Incidence and Outcomes of Acute Myocardial Infarction in Pneumonia associated Sepsis
Background:
Patients hospitalized for sepsis have an increased predisposition to develop acute myocardial infarction AMI. Pneumonia (PNA) is a common cause of sepsis and AMI is a known complication of PNA. Data are scare regarding the incidence and outcomes of AMI complicating PNA-sepsis
Methods:
We analyzed the United States National Inpatient Sample years 2005-2014 using ICD-9 codes to identify a weighted sample of hospitalizations in adult patients for sepsis. In this cohort, admissions with a secondary diagnosis of PNA and AMI were identified. PNA-sepsis was defined as sepsis admissions with underlying PNA. Invasive strategy was defined as the utilization of either coronary angiography, percutaneous coronary intervention PCI, or coronary artery bypass grafting (CABG). We analyzed differences in rates of AMI and associated inpatient mortality with and without PNA, rates of angiography, PCI, and CABG with AMI in PNA-sepsis, and differences in inpatient mortality with and without an invasive strategy for AMI in PNA-sepsis. Survey design based statistical tests were used for analyses.
Results:
In sepsis admissions in adult patients (N=8,995,716), PNA was present in 2,912,472 (32.5%) and AMI in 454,679 (5.1%). In sepsis admissions, AMI occurred at a 54% higher rate when PNA was present (6.6%) than without PNA (4.3%; P<0.001). Inpatient mortality with AMI complicating sepsis was 30.4% and was significantly higher when PNA was present (31.2%) than without (29.9%; P<0.001). When AMI complicated PNA-sepsis (N=190,987), angiography was performed in 9.8%, PCI in 3.1%, and CABG in 0.3%. Inpatient mortality was significantly lower in patients undergoing invasive strategy (12.4%) than conservative treatment (33.3%; P<0.001) of AMI in PNA-sepsis. After adjusting for patient demographics, comorbidities, hospital characteristics, and complications, an invasive strategy for AMI was associated with lower inpatient mortality (OR 0.31, 95% CI 0.28-0.35; model c-statistic 0.73) in PNA-sepsis
Conclusions:
Hospitalized patients with PNA-sepsis had a higher rate of AMI compared to non-PNA sepsis. AMI in PNA-sepsis was frequently managed conservatively. Invasive management of AMI in PNA-sepsis was associated with lower inpatient mortality