• Nicolas Allou, Caroline Brulliard, Dorothée Valance, Jean Baptiste Esteve, Olivier Martinet, Laure Corradi, Charlotte Cordier, Bruno Bouchet, and Jérôme Allyn.
• Réanimation polyvalente, Centre Hospitalier Universitaire Félix Guyon, Saint Denis, France. Electronic address: nicolas.allou@hotmail.fr.
• J Crit Care. 2016 Apr 1; 32: 159-64.

PurposeIt is difficult to differentiate type 1 acute myocardial infarction (AMI) with obstructive coronary artery disease (OCAD) from type 2 AMI in patients admitted for severe sepsis. The aims of this study were to assess the risk factors and prognosis of OCAD in patients admitted to the intensive care unit for severe sepsis with concomitant AMI.Materials And MethodsThis is a single-center retrospective cohort study including all consecutive patients who were hospitalized for severe sepsis or septic shock between March 2006 and September 2014 and who underwent coronary angiography in the intensive care unit to identify AMI.ResultsOverall, 78 (5.5%) of 1418 patients hospitalized for severe sepsis underwent coronary angiography to identify concomitant AMI. Thirty-two patients (41%) had OCAD. Following multivariate analysis, the risk factors of OCAD were peripheral vascular disease (odds ratio [OR] =5.7; 95% confidence interval [CI], 1.1-30.4; P = .042) and at least 2 cardiovascular risk factors (OR = 6.7; 95% CI, 1.9-23.8; P = .003). Obstructive coronary artery disease was associated with a significant mortality increase at 60 days (OR = 8.1; 95% CI, 1.9-30.2; P = .004).ConclusionsObstructive coronary artery disease is a poor prognosis factor in patients hospitalized for severe sepsis with concomitant AMI. In this setting, medical treatment should be considered for patients with peripheral vascular disease or with at least 2 cardiovascular risk factors; the need to perform coronary angiography should be considered carefully.Copyright © 2015 Elsevier Inc. All rights reserved.

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