Prognostic impact of previous and new myocardial infarction in patients with infective endocarditis.

BACKGROUND

Myocardial infarction (MI) impact in the outcome of infective endocarditis (IE) is unknown. Our aim was to evaluate the prevalence and prognostic influence of previous and new MI in a national cohort of IE.

METHODS

Our data come from the Spanish endocarditis registry. We included 6392 patients with IE between 2008 and 2023.

RESULTS

A total of 568 patients (8.8%) had a previous MI and 83 (1.3%) presented an acute MI (61 without MI history and 22 with reinfarction). Compared to those without previous MI, patients with previous MI had more advanced age (71 vs. 69 years, p < 0.001), were more frequently male (80.4% vs. 66.4%, p < 0.001), had higher age-adjusted Charlson Comorbidity Index (7 vs. 4, p < 0.001), and higher mortality (in-hospital 29.4% vs. 24.9%, one-year 35.4% vs. 30.7%, both p-values <0.001). However, previous MI was not an independent predictor of mortality (in-hospital odds ratio 0.90, 95% confidence interval [CI] 0.70-1.12, p = 0.42; one-year hazard ratio 0.81, 95% CI 0.64-1.02, p = 0.08). New acute MI was associated with mortality (in-hospital 48.2% vs. 25.0%, one-year 57.8% vs. 30.8%, both p-values <0.001) and was an independent predictor of mortality (in-hospital odds ratio 1.9, 95% CI 1.11-3.32, p = 0.02; one-year hazard ratio 2.26, 95% CI 1.32-3.89, p = 0.003).

CONCLUSIONS

IE patients that have a previous MI present an advanced age and frequent comorbidities, and these are the two main reasons for their high mortality. New acute MI duplicates in-hospital and one-year mortality.