Risk of Major Cardiovascular Events and All-Cause Death in Patients with Bronchiectasis and Associated Resistance to Antimicrobial Drugs

Aim: To assess the impact of antimicrobial resistance (AMR) on major adverse cardiovascular event (MACE) risk in patients with bronchiectasis. Methods: This retrospective study utilized data from the TriNetX research network, analysing patients with bronchiectasis categorized by the presence or absence of AMR. Primary outcomes included the risk of MACE (myocardial infarction, stroke and systemic thromboembolism, and cardiac arrest) and all-cause death. Cox regression analysis with 1:1 propensity score matching (PSM) was applied to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the primary outcomes. Subgroup analyses were conducted to validate results in clinically relevant subgroups. Results: Prior to PSM, patients with AMR (n=6,543, 61.0±22.0 years, 55.8% female) were younger, more often male, and presented a higher prevalence of cardiovascular risk factors than those without AMR (n=154,685, 67.3±16.0 years, 59.4% female). After PSM, no significant differences were found between groups. However, AMR patients showed a higher risk of MACE (HR 1.29, 95% CI 1.17-1.41) and all-cause death (HR 1.49, 95% CI 1.38-1.61) compared to non-AMR patients. The MACE risk was notably elevated among AMR patients without prior cardiovascular events (HR 1.56, 95% CI 1.34-1.81). Similar MACE risks were observed in cystic fibrosis (HR 1.24, 95% CI 0.86-1.78) and non-cystic fibrosis subgroups (HR 1.28, 95% CI 1.16-1.41), with consistent findings across different AMR types. Conclusions: In patients with bronchiectasis, AMR is associated with an increased risk of MACE and all-cause death, suggesting that controlling AMR spread may confer broader health benefits, particularly in reducing cardiovascular risk.