Acute infection is a frequent trigger of myocardial infarction (MI). However, whether post-infectious MI require specific acute care is still unknown.

We aimed to evaluate the prognostic impact of coronary angiography (CA) and MI drugs on cardiovascular (CV) and all-cause mortality in post-infectious MI patients.

Among 4573consecutive MI patients from the RICO Survey in intensive care units (ICU), 466 (10%) patients were diagnosed with a concurrent acute infection at admission. A Cox regression model was built including traditional MI prognosis factors and CV therapeutics, to evaluate their prognostic impact on one-year CV mortality.

Among the 466post-infectious MI patients, (mean age 78y), 313 (67%) had a respiratory tract infection, including 163acute bronchitis (35%), 150 (32%) pneumonia and 150 (33%) had non-respiratory infection. Among the 365patients who underwent CA, an atherothrombotic event (type 1 MI) was found in 130 (36%) patients. At one year follow-up, 108 patients were dead (23%), of whom 68 (15%) from CV cause. In Cox regression multivariable analysis, acute pneumonia was associated with a twice-higher risk of CV mortality (OR95% CI=2.31(1.16–4.60)), when compared with other infections. After adjustment on confounders, aspirin (OR 95%CI=0.23(0.11–0.52)), beta-blockers (OR95%CI=0.34 (0.16–0.72)), and Angiotensin Converting Enzyme inhibitors (ACEi) (OR95%CI=0.38(0.18–0.81) where associated with a lower CV mortality, whereas CA (OR95%CI=0.98 (0.53–1.80)) or statins (OR95%CI=0.78 (0.34–1.78)) were not significant estimates. Similar results were found after exclusion of type 1 MI.

In this first prognostic study in post-infectious MI in ICU, 1-Y CV mortality was very high (15%), especially after pneumonia. Moreover, aspirin, beta-blockers and ACEi, but not CA or statins, were associated with a lower risk of mortality.