Relation of Cardiac Complications in the Early Phase of Community-Acquired Pneumonia to Long-Term Mortality and Cardiovascular Events

      Community-acquired pneumonia (CAP) is complicated by cardiac events in the early phase of the disease. Aim of this study was to assess if these intrahospital cardiac complications may account for overall mortality and cardiovascular events occurring during a long-term follow-up. Three hundred one consecutive patients admitted to the University-Hospital, Policlinico Umberto I, with community-acquired pneumonia were prospectively recruited and followed up for a median of 17.4 months. Primary end point was the occurrence of death for any cause, and secondary end point was the occurrence of cardiovascular events (cardiovascular death, nonfatal myocardial infarction [MI], and stroke). During the intrahospital stay, 55 patients (18%) experienced a cardiac complication. Of these, 32 had an MI (29 non–ST-elevation MI and 3 ST-elevation MI) and 30 had a new episode of atrial fibrillation (7 nonmutually exclusive events). During the follow-up, 89 patients died (51% of patients with an intrahospital cardiac complication and 26% of patients without, p <0.001) and 73 experienced a cardiovascular event (47% of patients with and 19% of patients without an intrahospital cardiac complication, p <0.001). A Cox regression analysis showed that intrahospital cardiac complications, age, and Pneumonia Severity Index were significantly associated with overall mortality, whereas intrahospital cardiac complications, age, hypertension, and diabetes were significantly associated with cardiovascular events during the follow-up. In conclusion, this prospective study shows that intrahospital cardiac complications in the early phase of pneumonia are associated with an enhanced risk of death and cardiovascular events during long-term follow-up.
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      Linked Article

      • Cardiac Complications After Community-Acquired Pneumonia
        American Journal of CardiologyVol. 117Issue 2
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          We read with interest the report by Cangemi et al1 “Relation of cardiac complications in the early phase of community-acquired pneumonia (CAP) to long-term mortality and cardiovascular events” published in the August 5th issue of the American Journal of Cardiology. The investigators show that 18% of patients with CAP study develop intrahospital cardiac complications, defined as myocardial infarction (MI) and atrial fibrillation. Furthermore, the investigators prospectively show that these cardiac complications in the early phase of CAP are associated with adverse long-term cardiovascular prognosis (with the end point being cardiovascular death, nonfatal MI, and stroke).
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