Author + information
- Received February 28, 2012
- Accepted March 16, 2012
- Published online July 1, 2012.
- Adriano A.M. Truffa, MD⁎,
- Christopher B. Granger, MD⁎,
- Kyle R. White, MS⁎,
- L. Kristin Newby, MD, MHS⁎,
- Rajendra H. Mehta, MD, MS⁎,
- Judith S. Hochman, MD†,
- Manesh R. Patel, MD⁎,
- Karen S. Pieper, MS⁎,
- Hussein R. Al-Khalidi, PhD⁎,
- Paul W. Armstrong, MD‡ and
- Renato D. Lopes, MD, PhD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence
: Dr. Renato D. Lopes, Duke Clinical Research Institute, Department of Medicine, Box 3850, 2400 Pratt Street, Room 0311, Durham, North Carolina 27705
Objectives The aim of this study was to address the knowledge gap using the APEX-AMI (Assessment of Pexelizumab in Acute Myocardial Infarction) trial database. We also assessed the association between serious infections and 90-day death or death/myocardial infarction (MI).
Background Little is known about the incidence, location, etiological organisms, and outcomes of infection in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention.
Methods We analyzed data from 5,745 STEMI patients enrolled in the APEX-AMI trial. Detailed information on infection was collected for all patients. We described characteristics of patients according to infection and details of infection. Cox proportional hazards models were used to assess 90-day outcomes among patients with and without infections after adjusting for associated clinical variables and with infection as a time-dependent covariate.
Results Overall, 138 patients developed a serious infection (2.4%), most of whom presented with a single-site infection. The median (25th, 75th percentile) time until diagnosis of infection was 3 (1, 6) days. The most commonly identified organism was Staphylococcus aureus, and the main location of infection was the bloodstream. These patients had more comorbidities and lower procedural success at index percutaneous coronary intervention than those without infections. Serious infection was associated with significantly higher rates of 90-day death (adjusted hazard ratio: 5.6; 95% confidence interval: 3.8 to 8.4) and death or MI (adjusted hazard ratio: 4.9; 95% confidence interval: 3.4 to 7.1).
Conclusions Infections complicating the course of patients with STEMI were uncommon but associated with markedly worse 90-day clinical outcomes. Mechanisms for early identification of these high-risk patients as well as design of strategies to reduce their risk of infection are warranted.
(Pexelizumab in Conjunction With Angioplasty in Acute Myocardial Infarction [APEX-AMI]; NCT00091637)
The APEX-AMI trial was jointly funded by Procter & Gamble Pharmaceuticals and Alexion Pharmaceuticals. This analysis was supported by the Duke Clinical Research Institute. Dr. Granger has relationships with Astellas, AstraZeneca, Boehringer-Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Hoffmann-La Roche, Medtronic Foundation, Merck & Co., Novartis, Otsuka, Lilly, Pfizer, Sanofi-Aventis, and The Medicines Company. Mr. White was funded by National Institutes of Health training grant T32 HL079896, but NIH funding did not support this specific paper. Dr. Newby has received research grants from AstraZeneca, Bristol-Myers Squibb, diaDexus, Eli Lilly & Company, GlaxoSmithKline, Merck & Co., Murdock Study, NHLBI, Regado Biosciences Inc., and Roche; and has consulted for AstraZeneca, Daiichi-Sankyo, Eli Lilly & Company, Genentech, Johnson & Johnson, and Novartis. Dr. Hochman has relationships with Eli Lilly and Co., GlaxoSmithKline, Merck & Co., Bayer HealthCare AG, and Johnson & Johnson Pharmaceutical Research & Development. Dr. Patel has received research grants from NHLBI, AHRQ, Johnson & Johnson, AstraZeneca, and Maquet. Ms. Pieper is a consultant for AstraZeneca and Johnson & Johnson. Dr. Lopes has received a research grant from Bristol-Myers Squibb. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 28, 2012.
- Accepted March 16, 2012.
- American College of Cardiology Foundation