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32. Cardiovascular Nursing
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Predictors and Outcomes of Infection in Patients with ST-elevation Myocardial Infarction
Session:
Painel 6 - Doença Coronária 10
Speaker:
Ricardo Costa
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.7 Acute Coronary Syndromes - Other
Session Type:
Posters
FP Number:
---
Authors:
Ricardo Costa; Mariana Santos; Susete Vieira; André Luz; Marta Fontes Oliveira; André Dias De Frias; Andreia Campinas; Mário Silva Santos; Severo Torres
Abstract
<p><strong>Introduction: </strong>Nosocomial infections are related to a heightened morbidity and mortality across a wide spectrum of hospitalized patients. The impact of nosocomial infection on patients admitted with ST-elevation Myocardial Infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI) is scarce. We aimed to study the incidence and predictors of infection in a contemporary series of STEMI-patients and to ascertain its impact at 1-year incidence of major adverse cardio-cerebrovascular events (MACCE).</p> <p><strong>Methods and Results</strong>: Medical charts from 1119 STEMI-patients treated by pPCI from January 2008 to December 2018 were reviewed. 126 (11.1%) infections were diagnosed during hospital stay, mostly of respiratory (50.79%) and urinary (39.68%) tract origin. The median time until the diagnosis was 3 days (2-6). Insulin-treated diabetics were more than 3 times more likely to develop an infection during hospital stay (OR 3.41, 95% CI 1.53-7.56, p=0.003). Other independent predictors of infection were presence of peripheral arterial disease (OR 2.74, 95% CI 1.52-4.95, p=0.031), the need of an intra-aortic balloon pump insertion (OR 3.09, 95% CI 1.12-8.47, p=0.029), age (OR 1.05, 95% CI 1.02-1.07, p<0.001), lower systolic blood pressure (OR 0.99, 95% CI 0.99-1.00, p=0.002) and higher peak creatine kinase (CK; OR 1.12, 95% CI 1.03-1.22, p=0.011). On the contrary, pre-infarction angina was negatively related to infection (OR 0.56, 95% CI 0.33-0.95, p=0.031). On a Cox-proportional hazards model, MACCE were independently related to peripheral arterial disease (HR 3.16, 95% CI 2.05-4.87, p<0.001), age (HR 1.02, 95% CI 1.00-1.04, p=0.037), lower haemoglobin (HR 0.85, 95% CI 0.77-0.94, p=0.002) and lower systolic blood pressure on admittance (HR 0.99, 95% CI 0.98-1.00, p=0.003), higher peak CK (HR 1.11, 95% CI 1.04-1.19, p=0.002) and femoral approach (HR 1.85, 95% CI 1.30-2.64, P=0.001), but not in-hospital infection (HR 1.24, 95% CI 0.80-1.94, p=0.336).</p> <p><strong>Conclusion:</strong> In-hospital infection was relatively prevalent and was related to larger infarct size and co-morbidities. Mid-term prognosis is still dependant on traditional clinical features which usually accompany infection, but not infection <em>per se</em>.</p>
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