Corticosteroid Use and Incident Myocardial Infarction in Adults Hospitalized for Community-acquired Pneumonia

• DOI: 10.1513/annalsats.201806-419oc
• Publication Date: 2018-09-06T15:40:28Z
• Authors: Roberto Cangemi; Marco Falcone; Gloria Taliani; Camilla Calvieri; Giusy Tiseo; Giulio Francesco ...; Giuliano Bertazzoni; Alessio Farcomeni; Francesco Violi; Simona Battaglia; Elisa Biliotti; Cinzia Myriam Cal...; Andrea Celestini; Marco Casciaro; Maurizio De Angelis; Ilaria Di Diego; Paolo De Marzio; Rozenn Esvan; Giovanni Ferraro; Lucia Fontanelli ...; Cristiana Franchi; Laura Giordo; Fuad Khoury; Sergio Morelli; Giulia Naspi Catassi; Paolo Palange; Daniele Pastori; Anna Prosperi; Valeria Raparelli; Marco Rivano Capp...; Elisabetta Rossi; Maria Gabriella S...; Stefano Trapè; Filippo Toriello; Marco Vano; Mario Venditti
• Keywords: Pulmonary and Respiratory Medicine; Male; Myocardial Infarction; 610; Kaplan-Meier Estimate; corticosteroids; myocardial infarction; pneumonia; 03 medical and health sciences; 0302 clinical medicine; Adrenal Cortex Hormones; Risk Factors; Corticosteroid; Humans; Hospital Mortality; Propensity Score; Aged; Proportional Hazards Models; Retrospective Studies; Aged, 80 and over; Incidence; Pneumonia; Middle Aged; Corticosteroids; Myocardial infarction; Pneumonia; Pulmonary and Respiratory Medicine; corticosteroids; myocardial infarction; pneumonia; pulmonary and respiratory medicine; 3. Good health; Community-Acquired Infections; Myocardial infarction; Italy; Settore SECS-S/01 - STATISTICA; Corticosteroids, Myocardial infarction, Pneumonia, pulmonary and respiratory medicine; Female

Adults hospitalized for community-acquired pneumonia (CAP) have an increased risk of myocardial infarction. Corticosteroid treatment lowers CAP morbidity and mortality, but it is not known whether it influences in-hospital myocardial infarction.The aim of the present study was to investigate the potential interplay between corticosteroid treatment and in-hospital myocardial infarction in adults with CAP.We retrospectively analyzed adults with CAP referred to the University Hospital Policlinico Umberto I (Rome, Italy), consecutively recruited, and prospectively followed until discharge. The primary outcome was the occurrence of myocardial infarction during hospitalization. We used propensity score-adjusted Cox models to examine the association between corticosteroid use and myocardial infarction.Seven hundred fifty-eight patients (493 males, 265 females; mean ± standard deviation age, 71.7 ± 14.4 yr) were included in the study. Of these, 241 (32%) were treated with systemic corticosteroids (methylprednisolone, betamethasone, or prednisone). During follow-up, 62 (8.2%) had a myocardial infarction during their hospitalization (incidence, 0.72 per 100 person-days; 95% confidence interval [CI], 0.55 to 0.92). Those treated with corticosteroids had a lower incidence of myocardial infarction (0.42 per 100 person-days) than those not treated with corticosteroids (0.89 per 100 person-days; absolute rate difference, -0.48 per 100 person-days; 95% CI, -0.85 to -0.10). In a propensity score-adjusted Cox model, corticosteroid use was associated with a lower incidence of myocardial infarction (hazard ratio, 0.46; 95% CI, 0.24 to 0.88; P = 0.02).We found that in-hospital corticosteroid treatment was associated with a lower incidence of myocardial infarction in adults hospitalized with CAP.