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#Grand Rounds

Is Acute Myocardial Infarction Associated with the Flu?

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BACKGROUND AND PURPOSE:

  • Acute myocardial infarction has been associated with respiratory infection especially in older individuals who are at higher CVD risk
  • Quality studies remain limited
  • Kwong et al. (NEJM, 2018) evaluated the association between laboratory-confirmed influenza infection and acute myocardial infarction

METHODS:

  • Self-controlled case-series design
    • Index date for defining the exposure (laboratory-confirmed influenza infection) was set as the date the respiratory specimen was obtained
    • Observation period was set as the interval from 1 year before to 1 year after the index date
    • Included patients who had at least one admission for acute myocardial infarction during this period
  • Influenza infection was confirmed using high-specificity laboratory results
  • Hospitalization for acute myocardial infarction was confirmed using administrative data
  • Participants:
    • All Ontario residents registered with publicly funded health insurance
    • Those hospitalized for one or more respiratory viruses
      • ≥35 years at testing
    • Those hospitalized for an acute myocardial infarction
  • Risk interval: Defined as the first 7 days after respiratory specimen collection
  • Control interval: Defined as 1 year before and 1 year after the risk interval
  • To examine the specificity, analyses were performed looking at viral exposures other than influenza

RESULT:

  • 364 hospitalizations occurred for acute myocardial infarction within 1 year before and 1 year after a positive test result for influenza
  • Patient demographics
    • median age 77 years
    • 48% of the patients were female
    • 24% had had a previous hospitalization for acute myocardial infarction
    • 49% had CVD risk factors including diabetes, dyslipidemia, and hypertension
    • 31% had received flu vaccine
    • 82% of infections were due to influenza A
  • Of these, 20 (20.0 admissions per week) occurred during the risk interval and 344 (3.3 admissions per week) occurred during the control interval
  • The incidence ratio of an admission for acute myocardial infarction during the risk interval as compared with the control interval was 6.05 (95% CI, 86-9.50)
  • After day 7, no increased incidence was observed
  • Analysis by virus and type
    • 10.11 (95% CI, 4.37 to 23.38) after influenza B detection
    • 5.17 (95% CI, 3.02 to 8.84) after influenza A detection
    • 3.51 (95% CI, 1.11 to 11.12) after respiratory syncytial virus detection
    • 2.77 (95% CI, 1.23 to 6.24) after other viruses were detected

CONCLUSION:

  • There is a statistically increased incidence of acute myocardial infarction (6x) during the 7 days after laboratory confirmation of influenza infection as during the 1 year time interval before and after a positive flu test.
  • There appears to be a significant association between respiratory infections, especially influenza, and acute myocardial infarction

Learn More – Primary Sources:

Acute Myocardial Infarction after Laboratory-Confirmed Influenza Infection

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