Association between age and infection in patients with acute ST-elevation myocardial infarction.

BACKGROUND

ST-elevation myocardial infarction (STEMI) in young patients has a unique risk profile. We aimed to detect bacteria in aspirate of infarct artery in young versus old patients.

RESULTS

Aspirates of consecutive 140 patients who underwent a primary coronary intervention were taken for bacteriological, microscopical, and immunohistochemical (for bacterial pneumolysin) examinations. Their results were calculated in young (≤ 50 years) versus old (> 50 years) patients. Median age (interquartile range) was 45 (38-48) years in young (60 patients) and 59 (55-65) years in old (80 patients) patients, p < 0.0001. Both groups had similar baseline data except age, males, diabetes, hyperlipidemia, family history, lesion length, and ectatic vessel. Different bacteria were cultured in 11.3% of all patients involving 22.6% of young and 2.8% of old patients [hazard ratio 8.03 (95% CI 1.83-51.49), p = 0.002]. By multivariate analyses, age groups and leukocytic count were independent predictors of infection (bacteria and pneumolysin), p = 0.027 and p < 0.0001, respectively. Optimal cutoff value of leukocytic count was 12,250 cells/μl [ROC curve sensitivity 85.7%, specificity 86.4%, and AUC 0.97 (95% CI 0.95-1.0), p < 0.001]. Infection was an independent predictor of STEMI in young versus old patients, p < 0.001. Nevertheless, in-hospital events occurred insignificantly different and neither age groups nor infection was predictor of in-hospital events.

CONCLUSIONS

Young patients had significantly higher percentage of bacteria in their infarcted artery than old patients. High leukocytic count in patients below 50 predicts infection that causes acute myocardial infarction. Antibacterial trials directed toward this group are required for secondary prevention.