Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan.
Int J Infect Dis. 2019 Feb;79:169-178. doi: 10.1016/j.ijid.2018.11.021. Epub 2018 Nov 29.
Although the association between systemic infection and cardiovascular events has been identified, uncertainty remains regarding the incidence and prognosis of sepsis in acute myocardial infarction (AMI). The purpose of this research was to assess the impact of sepsis on survival after first AMI.
This was a nationwide cohort study involving the analysis of data from the Taiwan National Health Insurance Research Database for the period 2000-2012, for patients with a primary diagnosis of first AMI. Among the 186112 prospective patients, sepsis was diagnosed in 13065 (7.0%). The propensity score matching technique was used to match 13065 controls to the patients with sepsis and AMI with similar baseline characteristics. Cox proportional hazards regression models, including sepsis, percutaneous coronary intervention (PCI), and comorbidities, were performed to further evaluate the different influences on the mortality risk in patients hospitalized for first AMI.
Overall, the 12-year survival rate was lower in AMI patients with sepsis than in those without sepsis (log rank p-value <0.001); this was also shown in the different age and sex groups. The AMI patients with sepsis had a longer length of hospital stay than those without sepsis (32.5days vs. 11.74 days, p<0.001). In the Cox proportional hazards regression analysis, sepsis was an independent risk factor for mortality in patients after AMI (hazard ratio 1.78; 95% confidence interval 1.72-1.83). Interventional management with PCI or coronary artery bypass grafting improved survival in both the sepsis and non-sepsis patients after first AMI.
In conclusion, sepsis significantly increased the mortality risk of patients after first AMI. PCI may improve the long-term survival of patients in comparison to those managed conservatively.
虽然已经确定了全身感染与心血管事件之间的关联，但关于急性心肌梗死（AMI）中脓毒症的发生率和预后仍存在不确定性。本研究旨在评估脓毒症对首次 AMI 后生存的影响。
这是一项全国性队列研究，涉及对 2000 年至 2012 年台湾全民健康保险研究数据库数据的分析，纳入的患者均有首次 AMI 的主要诊断。在 186112 例前瞻性患者中，有 13065 例（7.0%）被诊断为脓毒症。采用倾向评分匹配技术，将 13065 例对照与 AMI 合并脓毒症且基线特征相似的患者进行匹配。采用 Cox 比例风险回归模型（包括脓毒症、经皮冠状动脉介入治疗（PCI）和合并症）进一步评估不同因素对首次 AMI 住院患者死亡风险的不同影响。
总体而言，脓毒症合并 AMI 患者的 12 年生存率低于无脓毒症的患者（log rank p 值<0.001）；在不同年龄和性别组中也有此表现。脓毒症合并 AMI 患者的住院时间长于无脓毒症的患者（32.5 天比 11.74 天，p<0.001）。在 Cox 比例风险回归分析中，脓毒症是 AMI 患者死亡的独立危险因素（危险比 1.78；95%置信区间 1.72-1.83）。与保守治疗相比，PCI 或冠状动脉旁路移植术等介入治疗可改善脓毒症和非脓毒症患者首次 AMI 后的长期生存。
综上所述，脓毒症显著增加了首次 AMI 后患者的死亡风险。与保守治疗相比，PCI 可能改善患者的长期生存。
