Resident's project wins recognition

A medical resident's casual observation of a link between recurrent urinary tract infections and acute coronary syndromes led him to study a series of cases and resulted in a novel finding: Patients with heart problems are three times more likely to have urinary tract infections at the time of their cardiac event than those without problems.

This finding suggests that the underlying infection and subsequent inflammation may be a precipitator of acute syndromes in patients with coronary artery disease, said Dr. John Sims, who presented his findings at the American College of Cardiology 2004 Scientific Sessions in New Orleans.

Dr. Sims' research abstract was selected for a feature presentation at the scientific sessions, an unusual recognition for a medical resident, said Dr. Darren McGuire, assistant professor of internal medicine who assisted with the study design.

"This in an interesting observation and the overall project is quite noteworthy, given the independent initiative John has demonstrated," Dr. McGuire said.

Besides designing the six-month study with Dr. McGuire, the 29-year-old resident completed all of the Institutional Review Board regulatory requirements, chart reviews and data management.

"I think this abstract was selected because it was a simple yet novel study," Dr. Sims said.

Acute coronary syndromes can range from unstable angina (chest pain) to heart attacks. These life-threatening disorders are a major cause of emergency medical care and hospitalization in the United States.

Dr. Sims and his collaborators evaluated the prevalence of urinary tract infections among 100 consecutive acute coronary syndrome patients treated at Parkland Memorial Hospital. The researchers compared the group with 100 patients awaiting a coronary bypass surgery.

Urinary tract infections were present in 27 of the patients with ACS and 11 of the control group. The condition also was more prevalent in older individuals, women, diabetics and people with a history of hyperlipidemia, hypertension and renal insufficiency.

"Data from this study reiterates that infection may play a role in triggering ACS and these results should challenge physicians to view ACS as an inflammatory disease, Dr. Sims said. "Treating patients with sub-clinical infections like urinary tract infections when they present to the emergency room may halt inflammatory mediators and prohibit adverse cardiac events."

Others researchers involved in the study included Drs. James de Lemos and John Warner, both assistant professors of internal medicine; Dr. Param Maewal, internal medicine resident; and Velma Yettman, a research coordinator.

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