Incidence and prognostic value of infections during an acute coronary syndrome

Abstract

Introduction: A growing amount of clinical and experimental evidence suggests a link between infection and atherosclerotic diseases. On the one hand it is known that during the acute phase of myocardial infarction there is a proinflammatory state. On the other hand several studies have demonstrated that infection causes a hypercoagulable state which increases the risk of thrombosis. The aim of our research is to evaluate the incidence of infections during the admission by acute coronary syndromes (ACS) and its influence in the risk of in-hospital mortality. Methods: Using data from 4,497 consecutive patients with ACS (32.1% STEMI, 19.2% unstable angina) from our hospital (2003-2010), we analyzed the incidence of bacterial and viral acute infections and associated it with inhospital mortality. Futher a multivariate analysis was performed to show the prognostic value of infections during ACS regardless of the GRACE risk score. Results: There were 534 infections during ACS hospitalization (11.9%) and 265 in-hospital deaths (5.9%). The mortality in the group with infections was 17.6%, increasing in-hospital mortality 3.8-fold in comparison with not-infection group (mortality 4.6%, p<0.001). In multivariate analysis, infections during ACS resulted as a predictor of in-hospital death independently of GRACE risk score (OR: 1.584, 95% CI: 1.141-2.198, p=0.006 for acute infections; OR: 1.035, 95% CI: 1.032- 1.039, p<0.001 for GRACE RS). Conclusions: Infections are a frequent complication during the ACS hospitalization increasing the risk of in-hospital mortality independently of GRACE risk score.