Corrales-Medina Vicente F, Serpa Jose, Rueda Adriana M, Giordano Thomas P, Bozkurt Biykem, Madjid Mohammad, Tweardy David, Musher Daniel M
From the Departments of Medicine (VFCM, JS, TPG, BB, MM, DT, DMM) and Molecular Virology and Microbiology (DT, DMM), Baylor College of Medicine, Houston; the Medical Care Line, Infectious Disease Section (AMR, DMM) and Cardiology Section (BB), Michael E. DeBakey Veterans Affairs Medical Center, Houston; and the Texas Heart Institute (MM), University of Texas Health Science Center, Houston, Texas.
Medicine (Baltimore). 2009 May;88(3):154-159. doi: 10.1097/MD.0b013e3181a692f0.
A link between acute infections and the development of acute coronary syndromes (ACS) has been proposed. We used retrospective cohort and self-controlled case series analyses to define the closeness of the association between acute bacterial pneumonia due to Streptococcus pneumoniae or Haemophilus influenzae and ACS. For the retrospective cohort analysis we included a control group of patients with admission diagnoses other than pneumonia or ACS. For the self-controlled case series analysis, we made within-person comparisons of the risk for ACS during the 15 days after admission for pneumonia with that of 365 days before and after that event. In 206 pneumonia patients (144 S. pneumoniae, 62 H. influenzae) we identified 22 (10.7%) cases of ACS, which compared to 6 (1.5%) among 395 controls resulted in an odds ratio (OR) of 7.8 (95% confidence interval [CI], 3.1-19.4). With multivariate logistic regression analysis, the OR for ACS in the pneumonia group remained elevated (OR, 8.5; 95% CI, 3.4-22.2). By the self-controlled case series method, the risk of ACS remarkably increased during the first 15 days after the diagnosis of pneumonia (incidence rate ratio, 47.6; 95% CI, 24.5-92.5). The characteristics and strength of these associations suggest a causal role for the acute infection in this relationship.
急性感染与急性冠脉综合征（ACS）的发生之间的联系已被提出。我们采用回顾性队列研究和自我对照病例系列分析来确定肺炎链球菌或流感嗜血杆菌所致急性细菌性肺炎与ACS之间关联的紧密程度。在回顾性队列研究中，我们纳入了入院诊断不是肺炎或ACS的患者作为对照组。在自我对照病例系列分析中，我们对肺炎患者入院后15天内发生ACS的风险与该事件前后365天内的风险进行了个体内比较。在206例肺炎患者（144例肺炎链球菌链球菌，66666链球菌，62例流感嗜血杆菌）中，我们确定了22例（10.7%）ACS病例，而在395例对照中为6例（1.5%），比值比（OR）为7.8（95%置信区间[CI]，3.1 - 19.4）。通过多因素逻辑回归分析，肺炎组发生ACS的OR仍然升高（OR，8.5；95%CI，3.4 - 22.2）。通过自我对照病例系列方法，在肺炎诊断后的前15天内，ACS的风险显著增加（发病率比，47.6；95%CI，24.5 - 92.5）。这些关联的特征和强度表明急性感染在这种关系中起因果作用。
