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Acute Bacterial Pneumonia is Associated With the Occurrence of Acute Coronary Syndromes

Corrales-Medina, Vicente F. MD; Serpa, Jose MD; Rueda, Adriana M. MD; Giordano, Thomas P. MD, MPH; Bozkurt, Biykem MD; Madjid, Mohammad MD; Tweardy, David MD, PhD; Musher, Daniel M. MD

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.

Abbreviations: ACS = acute coronary syndromes, CI = confidence interval, ICU = intensive care unit, IRR = incidence rate ratio, OR = odds ratio.

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.

Received October 16, 2008, and in revised form March 19, 2009.

Accepted for publication March 21, 2009.

Reprints: Vicente F. Corrales-Medina, MD, Infectious Disease Section, Room 4B-370, Michael E. DeBakey VA Medical Center, Houston, TX 77030; (e-mail:

© 2009 by Lippincott Williams & Wilkins, Inc.