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Recent COVID-19 and mortality after myocardial infarction: a Danish nationwide cohort study
Katrine D Brodersen1,2, Sinna P Ulrichsen1,2, Signe Sørup1,2
1Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus N, Denmark.
Insights
Recent coronavirus disease 2019 (COVID-19) infection increases short-term mortality risk for patients experiencing myocardial infarction (MI), particularly those unvaccinated. Vaccination may mitigate this risk.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Myocardial infarction (MI) is a known complication of coronavirus disease 2019 (COVID-19).
- Outcomes for MI patients with recent COVID-19 infection are not well-established.
- The impact of COVID-19 vaccination on MI prognosis requires further investigation.
Purpose of the Study:
- To investigate the association between recent COVID-19 and mortality following a first-time myocardial infarction.
- To evaluate the prognostic significance of COVID-19 vaccination status in MI patients with recent COVID-19 infection.
Main Methods:
- Nationwide, population-based cohort study using linked Danish registries (May 2020 - March 2022).
- Included adults admitted with a first-time MI.
- Exposure: Recent COVID-19 (positive PCR test within 90 days before to day of MI).
- Outcomes: All-cause mortality at 30 and 180 days post-MI.
- Statistical analysis: Cox proportional-hazards regression with inverse probability weighting, stratified by vaccination status.
Main Results:
- 12,054 MI patients included; 337 had recent COVID-19.
- Recent COVID-19 was associated with increased 30-day mortality (adjusted HR 1.64) and 180-day mortality (adjusted HR 1.28).
- The increased mortality risk was significantly higher in unvaccinated MI patients (30-day HR 2.88; 180-day HR 2.09) compared to vaccinated patients.
Conclusions:
- Recent COVID-19 infection is linked to elevated short-term mortality after myocardial infarction.
- The prognostic impact of recent COVID-19 on MI mortality is substantially greater in unvaccinated individuals.
- COVID-19 vaccination appears to attenuate the adverse effects of recent infection on MI outcomes.
Aims:
Coronavirus disease 2019 (COVID-19) may trigger myocardial infarction (MI). However, the outcomes of MI following recent COVID-19 remain largely unexplored. Consequently, we examined the association between recent COVID-19 and mortality after MI and the prognostic importance of COVID-19 vaccination.
Methods:
With data from linked Danish registries, we conducted a nationwide, population-based cohort study including adults admitted with a first-time MI to a Danish hospital from May 26, 2020, to March 9, 2022. The exposure was recent COVID-19 (positive polymerase chain reaction test in the period from 90 days before to the day after MI). Primary outcomes were all-cause mortality within 30 or 180 days after MI. We calculated absolute risk estimates and computed hazard ratios (HRs) with 95% confidence intervals (CIs) with a Cox proportional-hazards regression controlled for age, sex, comorbidity burden, and use of selected drugs using stabilized inverse probability weighting. We stratified by prior COVID-19 vaccination.
Results:
Of 12,054 included MI patients, 337 had recent COVID-19. Comparison of MI patients with versus without recent COVID-19 yielded an adjusted HR of 1.64 (95% CI: 1.16-2.31) for 30-day mortality and 1.28 (95% CI: 0.92-1.78) for 180-day mortality after MI. The adjusted HR was higher among unvaccinated MI patients (2.88, 95% CI: 1.78-4.64 for 30-day mortality; 2.09, 95% CI: 1.30-3.36 for 180-day mortality) than vaccinated patients (1.11, 95% CI: 0.65-1.90 and 0.97, 95% CI: 0.60-1.56, respectively).
Conclusion:
Recent COVID-19 was associated with increased short-term mortality after MI in patients without prior COVID-19 vaccination.
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