Corticosteroids May Prevent Myocardial Infarction in Community-Acquired Pneumonia

The addition of corticosteroids during in-hospital treatment for community-acquired pneumonia was associated with a lower incidence of myocardial infarction (MI), according to an analysis published in the Annals of the American Thoracic Society.

Researchers retrospectively examined 758 patients (493 men, 265 women) aged 71.7±14.4 years from a clinical trial (MAACE in Hospitalized Patients With Community-Acquired Pneumonia; ClinicalTrials.gov Identifier: NCT01773863). Comparison groups consisted of 241 patients who received corticosteroid treatment and 517 who did not. Patients in the corticosteroid therapy group received 20 to 80 mg of methylprednisolone per day, 4 to 8 mg betamethasone per day, or 25 to 50 mg prednisone per day.

Patients in the corticosteroid group tended to be older, to have a history of smoking, and to have a higher prevalence of chronic obstructive pulmonary disease and arterial hypertension. However, no significant history of cardiovascular events were noted between the comparison groups. 

During their hospital stay and 30-day follow-up period, 62 patients (8.2%) had an MI (0.72 per 100 person-days; 95% CI, 0.55-0.92). The group that received corticosteroid treatment had a lower incidence of MI (0.42 per 100 person-days) compared with the group that did not receive corticosteroids (0.89 per 100 person-days; absolute rate difference -0.48 per 100 person-days; 95% CI, -0.85 to 0.10).

A total of 33 patients died during hospitalization; 18 were cardiovascular deaths and 15 patients suffered strokes. During the follow-up period, 13 patients from the corticosteroid group and 27 patients from the noncorticosteroid group died (absolute rate difference 0.01 per 100 person-days; 95% CI, -0.11 to 0.13). 

Limitations for the study include the retrospective nature of the data and the fact that assignments for corticosteroid treatment were not random. The authors concluded that the association found between corticosteroid treatment and MI show that corticosteroid treatment could have a positive effect on the sequelae of community-acquired pneumonia by reducing morbidity and mortality. However, they emphasized the need for further clinical trial data to determine this association. 

Reference

Cangemi R, Falcone M, Taliani G, et al; in collaboration with the SIXTUS study group. 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