Fever in Myocardial Infarction-Related Cardiogenic Shock

Background

The role of fever in acute myocardial infarction-related cardiogenic shock (AMI-CS) in the contemporary era is not well described.

Objectives

The aim of the study was to describe the epidemiology of fever in AMI-CS and its impact on clinical outcomes.

Methods

Among all AMI-CS patients in the Northwell-Shock registry (n = 1,372), fever was identified via ≥2 temperatures ≥38.0 °C or one ≥38.3 °C. Characteristics, management, and outcomes were compared between patients with and without fever.

Results

Fever occurred in 40% of patients at a median of 2 days [0-6] after admission. Patients with fever were younger, more often male, and had higher shock severity, receiving more invasive treatment. Febrile patients received more antibiotics (84% vs 42%; P < 0.001), yet only 21% had positive microbial cultures. Early fever (<72 hours) was associated with a lower rate of positive cultures (13% vs 24%; P = 0.002). In-hospital mortality was similar between the groups (30% vs 31%; P = 0.78), but patients with fever had longer hospital stays (19 days vs 9 days; P < 0.001) and more discharges to skilled nursing facilities (49% vs 36%; P < 0.001). On multivariable logistic regression, female sex (OR: 1.9; P = 0.001), non-ST-segment elevation myocardial infarction etiology (OR = 1.5; P = 0.047), mechanical ventilation (OR: 2.1; P < 0.001), and acute dialysis (OR: 1.6; P = 0.040) were associated with positive cultures in febrile patients.

Conclusions

Fever in AMI-CS is common and is associated with greater illness severity but seems to be noninfectious in most cases. Further research should focus on improving antibiotic use in this population.