Master of Public Health

The risk of acute myocardial infarction among patients with laboratory-confirmed invasive pneumococcal disease: a self-controlled case series study

AUTHORS

ABSTRACT

BACKGROUND: Major cardiovascular events, including acute myocardial infarction (AMI), have been reported among patients with certain viral and bacterial infections. Yet, whether invasive pneumococcal disease (IPD) increases the risk of AMI remains unclear. We examined whether laboratory-confirmed IPD was associated with the risk of AMI.

METHODS: We conducted a self-controlled case series analysis among adult Tennessee residents with evidence of a first AMI hospitalization (2003-2019). Patient follow-up started 1 year prior to the earliest AMI and continued through the date of death, 1 year after AMI or end of study (12/2019). Periods for AMI assessment included the 7 to 1 days before IPD-specimen collection (pre IPD detection), day 0 through day 7 after IPD-specimen collection (current IPD), the 8 to 28 days after IPD-specimen collection (post IPD), and a control period (all other follow-up time). We used conditional Poisson regression to calculate incidence rate ratios and 95% confidence intervals (CI) for each risk period compared to control periods using within-person comparisons.

RESULTS: We studied 324 patients hospitalized for AMI with a laboratory-confirmed IPD within 1 year before or after the AMI hospitalization. The incidence of AMI was significantly higher during the pre-IPD detection period (IRR:10.29; CI:6.33-16.73) and current IPD (IRR: 92.95; CI:72.17-119.71) periods, but non-significantly elevated in the post-IPD risk period (IRR: 1.83; CI:0.86-3.91) compared to control periods. An elevated AMI incidence was also observed in the post-IPD control period (29 to 364 days after IPD) [IRR: 2.95; CI:2.01-4.32].

CONCLUSIONS: Hospitalizations with AMI were strongly associated with laboratory-confirmed IPD.

Tags: 2023 faculty publications