Impact of pulmonary infection and antibiotic use on recurrent myocardial infarction in patients with myocardial infarction

This study aims to evaluate the impact of pulmonary infections and antibiotic use on the recurrence of myocardial infarction (MI) in patients. A total of 3807 MI patients were included in this study. The effects of pulmonary infections and different antibiotics on recurrent MI were investigated using multivariable logistic regression and propensity score matching (PSM) analysis. Kaplan-Meier survival curves were used to compare the risk of recurrent MI between patients with and without pulmonary infections. In the multivariable logistic regression analysis, pulmonary infections significantly increased the risk of recurrent MI in patients with non-ST-segment elevation myocardial infarction (NSTEMI) (odds ratio [OR] = 1.47, 95% confidence interval [CI]: 1.22-1.79, P < 0.0001) and ST-segment elevation myocardial infarction (STEMI) (OR = 1.43, 95% CI: 1.15-1.80, P = 0.0016). PSM analysis showed that, without adjusting for antibiotic use, pulmonary infections significantly increased the risk of recurrent MI (NSTEMI: OR = 1.41, 95% CI: 1.12-1.79, P = 0.004; STEMI: OR = 1.48, 95% CI: 1.13-1.95, P = 0.0051). However, after adjusting for antibiotic use, the impact of pulmonary infections on recurrent MI was no longer significant (NSTEMI: OR = 0.91, 95% CI: 0.57-1.45, P = 0.691; STEMI: OR = 1.06, 95% CI: 0.80-1.41, P = 0.6925). Different antibiotics had significant effects on the risk of recurrent MI: quinolone antibiotics were associated with an increased risk, while cephalosporin antibiotics and metronidazole were associated with a decreased risk. Pulmonary infections significantly increase the risk of recurrent MI in patients, and antibiotic use can modify this effect. Clinically, the use of antibiotics and management of pulmonary infections should be carefully considered to optimize treatment strategies for MI patients.