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. 2023 Jun 16;76(12):2171-2177.
doi: 10.1093/cid/ciad065.

Risk of Acute Myocardial Infarction Among Patients With Laboratory-Confirmed Invasive Pneumococcal Disease: A Self-Controlled Case Series Study

Andrew D Wiese  1 , Ed Mitchel  1 , Danielle Ndi  1 , Tiffanie M Markus  1 , H Keipp Talbot  1   2 , William Schaffner  1   2 , Carlos G Grijalva  1   3   4
Affiliations

Risk of Acute Myocardial Infarction Among Patients With Laboratory-Confirmed Invasive Pneumococcal Disease: A Self-Controlled Case Series Study

Andrew D Wiese et al. Clin Infect Dis. .

Abstract

Background: Acute myocardial infarction (AMI) events have been reported among patients with certain viral and bacterial infections. 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 an AMI hospitalization (2003-2019). Patient follow-up started 1 year before the earliest AMI and continued through the date of death, 1 year after AMI, or study end (December 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), day 8 to 28 after IPD specimen collection (post-IPD), and a control period (all other follow-up). We used conditional Poisson regression to calculate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for each risk period compared with control periods using within-person comparisons.

Results: We studied 324 patients hospitalized for AMI with laboratory-confirmed IPD within 1 year before or after the AMI hospitalization. The incidence of AMI was significantly higher during the pre-IPD detection (IRR, 10.29; 95% CI: 6.33-16.73) and the current IPD (IRR, 92.95; 95% CI: 72.17-119.71) periods but nonsignificantly elevated in the post-IPD risk period (IRR, 1.83; 95% CI: .86-3.91) compared with control periods. The AMI incidence was higher in the post-IPD control period (29 to 365 days after IPD; IRR, 2.95; 95% CI: 2.01-4.32).

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

Keywords: acute myocardial infarction; invasive pneumococcal disease; self-controlled case series.

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Conflict of interest statement

Potential conflicts of interest. C. G. G. reports consulting fees and participation on a data and safety monitoring or advisory board from Merck, research support from the Campbell Alliance/Syneos Health, and grants or contracts from NIH, CDC, Agency for Healthcare Research and Quality, US Food and Drug Administration, and Campbell Alliance/Syneos Health. A. D. W. reports consulting fees from the Tennessee Department of Health and grants from NIH. W. S. serves as the medical director for the National Foundation for Infectious Diseases. H. K. T. and T. M. M. report grants or contracts from the CDC paid to their institution. All remaining authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Demonstration of baseline, control, and risk periods during follow-up. Patient A represents a patient with an AMI hospitalization identified in the post-IPD control period. Patient B represents a patient with an AMI hospitalization identified during a current IPD risk period (with IPD specimen collection date 1 day prior to date of admission for the AMI hospitalization). Patient C represents a patient with an AMI hospitalization during the pre-IPD control period. Abbreviations: AMI, acute myocardial infarction; IPD, invasive pneumococcal disease.
Figure 2.
Figure 2.
Distribution of dates for IPD specimen collection relative to date of AMI admission, 2004–2019. Day 7 to 1 before IPD specimen collection represents the pre-IPD detection period. Day 0 to Day 7 after IPD specimen collection represents the current IPD risk period. Day 8 to 28 after IPD specimen collection represents the post-IPD risk period. Abbreviations: AMI, acute myocardial infarction; IPD, invasive pneumococcal disease.
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