- Email: [email protected]
Myocardial Infarction in Patients With Pneumonia
JACC VOL. 65, NO. 14, 2015
Letters
APRIL 14, 2015:1484–94
Carlos G. Santos-Gallego, MD *Juan Badimon, PhD
cyclooxygenase inhibition. However, the authors did
*Atherothrombosis Research Unit
in hospital stay. Therefore, increased TxB2 levels
Cardiovascular Institute
cannot be associated with MI. This issue should
Icahn School of Medicine at Mount Sinai
be clarified to correct the interpretation of study
One Gustave Levy Place
results.
Box 1030
not mention the usage of NSAIDs on admission or
On the other hand, there are some doubts about
New York, New York 10029
the diagnosis of MI. In the study, 24% of all patients
E-mail: [email protected]
with pneumonia had renal failure. The patients
http://dx.doi.org/10.1016/j.jacc.2014.12.058
with renal failure had a high incidence of elevated troponin levels of about 94%, and this could be
REFERENCES 1. Ross R. Atherosclerosis—an inflammatory disease. N Engl J Med 1999;340: 115–26. 2. Mason JC, Libby P. Cardiovascular disease in patients with chronic inflammation: mechanisms underlying premature cardiovascular events in rheumatologic conditions. Eur Heart J 2015;36:482–9.
related with decreased glomerular filtration rate. Li et al. (3) stated that elevation of troponin T in chronic renal failure was common (63.4%) in the absence of MI defined by the usual criteria. The researchers concluded that troponins and electrocardiography (ECG) were necessary to detect MI. However, the
3. Dutta P, Courties G, Wei Y, et al. Myocardial infarction accelerates atherosclerosis. Nature 2012;487:325–9.
characteristics of ECG changes were unknown. Stein
4. Andraws R, Berger JS, Brown DL. Effects of antibiotic therapy on outcomes of patients with coronary artery disease: a meta-analysis of randomized controlled trials. JAMA 2005;293:2641–7.
previous cardiopulmonary disease, ECGs show ST-
et al. (4) reported that in pneumonia patients without segment or T-wave changes (21%). Therefore, the
5. Cangemi R, Casciaro M, Rossi E, et al., for the SIXTUS Study Group. Platelet activation is associated with myocardial infarction in patients with pneumonia. J Am Coll Cardiol 2014;64:1917–25.
characteristics of ECG changes and the results of
Myocardial Infarction in Patients With Pneumonia
*Goktug Savas, MD Nihat Kalay, MD
troponin monitoring should be explained before commenting on the study results.
*Erciyes University School of Medicine Department of Cardiology
We have read with great interest the report by Cangemi et al. (1) in a previous issue of the Journal. The authors reported that myocardial infarction (MI) is an early complication of pneumonia and
38039 Kayseri Turkey E-mail: [email protected] http://dx.doi.org/10.1016/j.jacc.2014.12.059
is associated with in vivo platelet activation and serum thromboxane B 2 (TxB 2) overproduction. The researchers found that the baseline serum TxB2 level was significantly higher in patients who develop signs of MI, and that in vivo platelet acti-
REFERENCES 1. Cangemi R, Casciaro M, Rossi E, et al., for the SIXTUS Study Group. Platelet activation is associated with myocardial infarction in patients with pneumonia. J Am Coll Cardiol 2014;64:1917–25.
vation and overproduction of serum TxB2 formation
2. Akagi Y, Nio Y, Shimada S, et al. Influence of nonsteroidal anti-inflammatory drugs on the antiplatelet effects of aspirin in rats. Biol Pharm Bull 2011;34:
were independently associated with MI in a patient
233–7.
with pneumonia. Also, the authors suggested that
3. Li D, Keffer J, Corry K, et al. Nonspecific elevation of troponin t levels in
increased TxB2 levels were associated with aspirin
patients with chronic renal failure. Clin Biochem 1995;28:474–7.
resistance and increased plaque rupture. Although
4. Stein PD, Matta F, Ekkah M, et al. Electrocardiogram in pneumonia. Am J Cardiol 2012;15:1836–40.
important findings, some issues should be considered in the interpretation of the study results. The patient with pneumonia may have used nonsteroidal anti-inflammatory drugs (NSAIDs) to
REPLY: Myocardial Infarction in Patients With Pneumonia
treat pain or fever. Previous studies in rats have shown that NSAIDs affect the serum TxB2 level.
We thank Drs. Savas and Kalay for their interest in our
Akagi et al. (2) reported that NSAIDs (ibuprofen,
paper (1).
loxoprofen sodium, and etodolac) affect the serum
Epidemiological studies have shown that respira-
level of TxB 2 in rats after oral administration. Also,
tory tract infections are associated with an increased
all NSAIDs can affect serum TxB2 levels because of
risk for the development of artery thrombosis as
1491
Letters
APRIL 14, 2015:1484–94
Carlos G. Santos-Gallego, MD *Juan Badimon, PhD
cyclooxygenase inhibition. However, the authors did
*Atherothrombosis Research Unit
in hospital stay. Therefore, increased TxB2 levels
Cardiovascular Institute
cannot be associated with MI. This issue should
Icahn School of Medicine at Mount Sinai
be clarified to correct the interpretation of study
One Gustave Levy Place
results.
Box 1030
not mention the usage of NSAIDs on admission or
On the other hand, there are some doubts about
New York, New York 10029
the diagnosis of MI. In the study, 24% of all patients
E-mail: [email protected]
with pneumonia had renal failure. The patients
http://dx.doi.org/10.1016/j.jacc.2014.12.058
with renal failure had a high incidence of elevated troponin levels of about 94%, and this could be
REFERENCES 1. Ross R. Atherosclerosis—an inflammatory disease. N Engl J Med 1999;340: 115–26. 2. Mason JC, Libby P. Cardiovascular disease in patients with chronic inflammation: mechanisms underlying premature cardiovascular events in rheumatologic conditions. Eur Heart J 2015;36:482–9.
related with decreased glomerular filtration rate. Li et al. (3) stated that elevation of troponin T in chronic renal failure was common (63.4%) in the absence of MI defined by the usual criteria. The researchers concluded that troponins and electrocardiography (ECG) were necessary to detect MI. However, the
3. Dutta P, Courties G, Wei Y, et al. Myocardial infarction accelerates atherosclerosis. Nature 2012;487:325–9.
characteristics of ECG changes were unknown. Stein
4. Andraws R, Berger JS, Brown DL. Effects of antibiotic therapy on outcomes of patients with coronary artery disease: a meta-analysis of randomized controlled trials. JAMA 2005;293:2641–7.
previous cardiopulmonary disease, ECGs show ST-
et al. (4) reported that in pneumonia patients without segment or T-wave changes (21%). Therefore, the
5. Cangemi R, Casciaro M, Rossi E, et al., for the SIXTUS Study Group. Platelet activation is associated with myocardial infarction in patients with pneumonia. J Am Coll Cardiol 2014;64:1917–25.
characteristics of ECG changes and the results of
Myocardial Infarction in Patients With Pneumonia
*Goktug Savas, MD Nihat Kalay, MD
troponin monitoring should be explained before commenting on the study results.
*Erciyes University School of Medicine Department of Cardiology
We have read with great interest the report by Cangemi et al. (1) in a previous issue of the Journal. The authors reported that myocardial infarction (MI) is an early complication of pneumonia and
38039 Kayseri Turkey E-mail: [email protected] http://dx.doi.org/10.1016/j.jacc.2014.12.059
is associated with in vivo platelet activation and serum thromboxane B 2 (TxB 2) overproduction. The researchers found that the baseline serum TxB2 level was significantly higher in patients who develop signs of MI, and that in vivo platelet acti-
REFERENCES 1. Cangemi R, Casciaro M, Rossi E, et al., for the SIXTUS Study Group. Platelet activation is associated with myocardial infarction in patients with pneumonia. J Am Coll Cardiol 2014;64:1917–25.
vation and overproduction of serum TxB2 formation
2. Akagi Y, Nio Y, Shimada S, et al. Influence of nonsteroidal anti-inflammatory drugs on the antiplatelet effects of aspirin in rats. Biol Pharm Bull 2011;34:
were independently associated with MI in a patient
233–7.
with pneumonia. Also, the authors suggested that
3. Li D, Keffer J, Corry K, et al. Nonspecific elevation of troponin t levels in
increased TxB2 levels were associated with aspirin
patients with chronic renal failure. Clin Biochem 1995;28:474–7.
resistance and increased plaque rupture. Although
4. Stein PD, Matta F, Ekkah M, et al. Electrocardiogram in pneumonia. Am J Cardiol 2012;15:1836–40.
important findings, some issues should be considered in the interpretation of the study results. The patient with pneumonia may have used nonsteroidal anti-inflammatory drugs (NSAIDs) to
REPLY: Myocardial Infarction in Patients With Pneumonia
treat pain or fever. Previous studies in rats have shown that NSAIDs affect the serum TxB2 level.
We thank Drs. Savas and Kalay for their interest in our
Akagi et al. (2) reported that NSAIDs (ibuprofen,
paper (1).
loxoprofen sodium, and etodolac) affect the serum
Epidemiological studies have shown that respira-
level of TxB 2 in rats after oral administration. Also,
tory tract infections are associated with an increased
all NSAIDs can affect serum TxB2 levels because of
risk for the development of artery thrombosis as
1491