Risk for Myocardial Infarction and Stroke after Community-Acquired Bacteremia: A 20-Year Population-Based Cohort Study
Background—Infections may trigger acute cardiovascular events, but the risk after community-acquired bacteremia is unknown. We assessed the risk for acute myocardial infarction and ischemic stroke within 1 year of community-acquired bacteremia.
Methods and Results—Population-based cohort study in Northern Denmark. We included 4389 hospitalized medical patients with positive blood cultures obtained on the day of admission. Patients hospitalized with bacteremia were matched with up to 10 general population controls and up to 5 acutely admitted non-bacteremic controls, matched on age, gender, and calendar-time. All incident events of myocardial infarction and stroke during the following 365 days were ascertained from population-based health-care databases. Multivariable regression analyses were used to assess relative risks (RR) with 95% confidence intervals (CI) for myocardial infarction and stroke among bacteremia patients and their controls. The risk for myocardial infarction or stroke was greatly increased within 30 days of community-acquired bacteremia: 3.6% vs. 0.2% among population controls (adjusted RR, 20.86; 95% CI, 15.38-28.29) and 1.7% among hospitalized controls (adjusted RR, 2.18; 95% CI, 1.80-2.65). The risks for myocardial infarction or stroke remained modestly increased from 31 to 180 days after bacteremia when compared to population controls (adjusted hazard ratio, 1.64; 95% CI, 1.18-2.27), but not vs. hospitalized controls (adjusted hazard ratio, 0.95; 95% CI, 0.69-1.32). No differences in cardiovascular risk were seen after more than 6 months. Increased 30-day risks were consistently found for a variety of etiologic agents and infectious foci.
Conclusions—Community-acquired bacteremia is associated with increased short-term risk of myocardial infarction and stroke.
- Received October 3, 2013.
- Revision received December 24, 2013.
- Accepted January 9, 2014.