Obstructive coronary artery disease in patients hospitalized for severe sepsis or septic shock with concomitant acute myocardial infarction

Abstract Purpose It is difficult to differentiate type 1 acute myocardial infarction (AMI) with obstructive coronary artery disease (OCAD) from type 2 AMI in patients admitted for severe sepsis. The aims of this study were to assess the risk factors and prognosis of OCAD in patients admitted to the...

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Bibliographic Details
Published in:Journal of critical care 2016-04, Vol.32, p.159-164
Main Authors: Allou, Nicolas, MD, Brulliard, Caroline, MD, Valance, Dorothée, MD, Esteve, Jean Baptiste, MD, Martinet, Olivier, MD, Corradi, Laure, MD, Cordier, Charlotte, MD, Bouchet, Bruno, MD, Allyn, Jérôme, MD
Format: Article
Language:English
Subjects:
Acute myocardial infarction
Aged
Cardiac arrhythmia
Cardiology
Cardiovascular risk factors
Coronary Angiography
Coronary Artery Disease - etiology
Coronary Artery Disease - mortality
Critical Care
Electrocardiography
Female
Heart attacks
Hospitalization
Humans
Intensive Care Units - statistics & numerical data
Male
Middle Aged
Mortality
Multivariate Analysis
Myocardial Infarction - etiology
Obstructive coronary artery disease
Prognosis
Retrospective Studies
Risk Factors
Septic shock
Severe sepsis
Shock, Septic - complications
Shock, Septic - mortality
Shock, Septic - therapy
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Summary:Abstract Purpose It is difficult to differentiate type 1 acute myocardial infarction (AMI) with obstructive coronary artery disease (OCAD) from type 2 AMI in patients admitted for severe sepsis. The aims of this study were to assess the risk factors and prognosis of OCAD in patients admitted to the intensive care unit (ICU) for severe sepsis with concomitant AMI. Materials and Methods A single-center retrospective cohort study including all consecutive patients who were hospitalized for severe sepsis or septic shock between March 2006 and September 2014 and who underwent coronary angiography in the ICU to identify AMI. Results Overall, 78 (5.5%) of 1,418 patients hospitalized for severe sepsis underwent coronary angiography to identify concomitant AMI. Thirty two patients (41%) had OCAD. Following multivariate analysis, the risk factors of OCAD were peripheral vascular disease (OR = 5.7 [95% CI: 1.1-30.4], P = 0.042) and ≥ 2 cardiovascular risk factors (OR = 6.7 [95%CI: 1.9-23.8], P = 0.003). Obstructive coronary artery disease was associated with a significant mortality increase at 60 days (OR = 8.1 [95%CI: 1.9-30.2], P = 0.004). Conclusions Obstructive coronary artery disease is a poor prognosis factor in patients hospitalized for severe sepsis with concomitant AMI. In this setting, medical treatment should be considered for patients with peripheral vascular disease or with ≥ 2 cardiovascular risk factors; the need to perform coronary angiography should be considered carefully.
ISSN:0883-9441
1557-8615
DOI:10.1016/j.jcrc.2015.12.014