Acute Infection and Myocardial Infarction

Musher DM, Abers MS, Corrales-Medina VF.
Acute Infection and Myocardial Infarction. N Engl J Med 2019;380:171-176.

The following are 10 key points to remember from this review on the association between acute infections and myocardial infarctions:

  1. An increase in the short-term risk of myocardial infarction has been described in various infectious processes including influenza, pneumonia, acute bronchitis, urinary tract infections, and bacteremia.
  2. The risk of myocardial infarction is more pronounced in chest infections; both viral and bacterial.
  3. The risk of myocardial infarction peaks at the onset of infection and is proportional to the severity of the illness.
  4. With mild respiratory or with urinary tract infections, the risk of myocardial infarction returns to baseline within months.
  5. With more severe infections such as pneumonia and sepsis, the risk declines slowly and may exceed the baseline risk for up to 10 years post-infection.
  6. Most myocardial infarctions associated with infections are likely caused by acute coronary occlusions (type I) rather than demand ischemia (type II) given the risk extends beyond the acute infectious period and hemodynamic instability.
  7. Purported mechanisms underlying the association between infections and type I myocardial infarctions include atheromatous plaque destabilization by activation of inflammatory cells, an overall prothrombotic and procoagulant milieu with higher levels of platelet activation and thromboxane synthesis, and expression of genes linked to platelet activation induced by respiratory viruses such as influenza.
  8. Purported mechanisms underlying the association between infections and type II myocardial infarctions include impaired coronary perfusion in the setting of increased metabolic needs, tachycardia, hypotension and toxin-mediated vasoconstriction, hypoxia in the setting of severe respiratory infections and cytokine storms, and direct myocardial injury not related to ischemia characterized by vacuolization.
  9. Influenza and pneumococcal vaccination reduce the risk of cardiovascular events by 36% and 17%, respectively.
  10. No studies have examined whether initiation of therapies such as statin or aspirin during acute infections mitigates the increased risk of myocardial infarction.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Lipid Metabolism

Keywords: Aspirin, Bacteremia, Bronchitis, Coronary Occlusion, Cytokines, Hypotension, Infections, Influenza, Human, Myocardial Infarction, Plaque, Atherosclerotic, Platelet Activation, Pneumonia, Primary Prevention, Respiratory Tract Infections, Risk Factors, Sepsis, Tachycardia, Thromboxanes, Urinary Tract Infections, Vaccination, Vasoconstriction, Viruses

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