Background: Pneumococcal vaccination has been reported to have confl icting results on preventing adverse cardiovascular events in a myriad of populations. We therefore investigated the effect of pneumococcal vaccination on preventing subsequent adverse cardiovascular events in a group of high-risk patients; those presenting with an ST-elevation myocardial infarction (STEMI). Methods: Patients undergoing acute percutaneous coronary intervention (PCI) for a STEMI at a single community referral hospital were prospectively entered into American College of Cardiology (ACC) cardiac catheterization/PCI registry. Information regarding pneumococcal vaccination and outcomes relating to recurrent MI and death were obtained from chart abstraction. Results: Four hundred and seventy-three patients underwent PCI for a STEMI from 1/1/2007 to 12/31/2010. The majority of patients were male (64.9%) and Caucasian (99.6%), with a mean age of 63.6 years (±13.8). During a median follow-up of 12.7 months, there were 69 (14.6%) deaths and 22 (4.5%) recurrent MIs. Patients who had received pneumococcal vaccination were at increased risk of mortality (hazard ratio = 2.08; 95% confi dence interval 1.34-3.23; P = 0.001). However, patients who had received pneumococcal vaccination were older, and more likely to have hypertension and diabetes. After correcting for confounders in a multivariate Cox regression model, there was no signifi cant association of pneumococcal vaccination with increased mortality. There was also no signifi cant difference in recurrent MI. Conclusion: Pneumococcal vaccination was not associated with differences in all-cause mortality or recurrent MI, after correcting for major confounding clinical variables. Given the confl icting fi ndings regarding pneumococcal vaccination, a prospective, randomized study will be required to clarify its cardio-protective role, if any.
Key words: Acute ST-elevation myocardial infarction, outcomes, pneumococcal vaccination.