COVID-19 a risk factor for acute MI, ischemic stroke
A new study identified COVID-19 as an independent risk factor for acute MI and ischemic stroke.
“Evidence focusing on the association between COVID-19 and cardiovascular complications is based on relatively small studies, limited to the pandemic’s early phase and includes mainly hospitalized patients — ie, those with severe disease,” Ioannis Katsoularis, MD, PhD student in the department of public health and clinical medicine at Umeå University, Sweden, Anne-Marie Fors Connolly, BSc, MSc, MD, PhD, MIMS Clinical Research Fellow Molecular Infection Medicine Sweden, Nordic EMBL Partnership for Molecular Medicine, Umeå University, and colleagues wrote in The Lancet. “Consequently, there is a need for studies at the population level to identify the burden of acute cardiovascular events following COVID-19.”
Researchers reported results of a self-controlled case series of 86,742 patients with COVID-19 (median age, 48 years; 57% women) from February to September 2020 and a matched cohort study of 348,481 age-, sex- and residence-matched individuals living in Sweden who served as controls.
In the self-controlled case series, 36 patients died and 186 first acute MI events were reported. The incidence rate ratio (IRR) for acute MI was significantly increased for the first week after COVID-19 (IRR = 2.89; 95% CI, 1.51-5.55), the second week (IRR = 2.53; 95% CI, 1.29-4.94) and third and fourth weeks (IRR = 1.6; 95% CI, 0.84-3.04) when the researchers excluded day of exposure from the risk period. When day of exposure was included, the IRR for acute MI risk remained increased for the first week after COVID-19 (IRR = 8.44; 95% CI, 5.45-13.08), the second week (IRR = 2.56; 95% CI, 1.31-5.01) and third and fourth weeks (IRR = 1.62; 95% CI, 0.85-3.09), according to the results.
In the case series, 254 first ischemic stroke events were reported during the study period. The IRR for ischemic stroke was significantly increased for the first week after COVID-19 (IRR = 2.97; 95% CI, 1.71-5.15), the second week (IRR = 2.8; 95% CI, 1.6-4.88) and third and fourth weeks (IRR = 2.1; 95% CI, 1.33-3.32) when day of exposure was excluded from the risk period. Again, when day of exposure was included, the IRR for ischemic stroke risk was increased by about six times for the first week after COVID-19 (IRR = 6.18; 95% CI, 4.06-9.42), by approximately three times for the second week (IRR = 2.85; 95% CI, 1.64-4.97) and by approximately two times for the third and fourth weeks (IRR = 2.14; 95% CI, 1.36-3.38), according to the results.
In the matched cohort study, when the day of exposure was excluded, the OR for acute MI was 3.41 (95% CI, 1.58-7.36) and the OR for ischemic stroke was 3.63 (95% CI, 1.69-7.8) in the first 2 weeks after COVID-19. These odds remained increased when the researchers included day of exposure: acute MI (OR = 6.61; 95% CI, 3.56-12.2) and ischemic stroke (OR = 6.74; 95% CI, 3.74-12.2).
“Our results indicate that acute cardiovascular complications might represent an essential clinical manifestation of COVID-19 and the long-term effects might be a challenge for the future,” the researchers wrote.