In-hospital treatment of adult community-acquired pneumonia (CAP) with corticosteroids may be associated with a lower risk for myocardial infarction (MI) compared with CAP not treated with corticosteroids, according to study findings published in the Annals of the American Thoracic Society.
Outcomes of consecutive patients with CAP who were treated at the University-Hospital Policlinico Umberto in Rome were retrospectively reviewed (n = 758). The primary endpoint was comprised of an acute in-hospital MI event. Disease severity at presentation was evaluated using the Pneumonia Severity Index (PSI), a prediction score for 30-day mortality.
Additionally, the investigators assessed the occurrence of other major cardiovascular events such as stroke, cardiovascular death, death from any cause during hospitalization, and mortality at 30 days.
In-hospital treatment with systemic corticosteroids occurred in 241 patients. Corticosteroids in this cohort included betamethasone, methylprednisolone, and prednisone.
During 30-day follow-up, a total of 62 patients experienced an MI during hospitalization, representing an incidence rate of 0.72 per 100 person-days (95% CI, 0.55 – 0.92).
In-hospital treatment with corticosteroids was associated with a lower incidence of MI compared with untreated patients (0.42 per 100 person-days vs 0.89 per 100 person-days, respectively; absolute rate difference -0.48 per 100 person/days; 95% CI, -0.85 to -0.10).
The use of corticosteroid medications was also associated with a lower MI incidence in the propensity-score adjusted Cox model (hazard ratio, 0.46; 95% CI, 0.24-0.88; P =.02).
The inclusion of patients treated at 1 center in Italy, the relatively small number of patients, and the limited follow-up duration represent the main limitations of the analysis.
Findings from this study suggest “a possible vascular protection effect at the level of the coronary tree in acute infections.”
Cangemi R, Falcone M, Taliani G, et al. Corticosteroid use and incident myocardial infarction in adults hospitalized for community-acquired pneumonia [published online September 6, 2018]. Ann Am Thorac Soc. doi: 10.1513/AnnalsATS.201806-419OC