COVID-19 and myocardial infarction
Authors: Daniel Caldeira, Fausto J Pinto
Journal: The Lancet (2021)

Ioannis Katsoularis and colleagues1Katsoularis I Fonseca-Rodríguez O Farrington P Lindmark K Fors Connolly A-M Risk of acute myocardial infarction and ischaemic stroke following COVID-19 in Sweden: a self-controlled case series and matched cohort study.Lancet. 2021; 398: 599-607Summary Full Text Full Text PDF PubMed Scopus (240) Google Scholar found that COVID-19 is a risk factor for myocardial infarction and stroke through self-controlled case series evaluation, a method that has been used to establish the risk of myocardial infarction associated with influenza infection.2Kwong JC Schwartz KL Campitelli MA et al.Acute myocardial infarction after laboratory-confirmed influenza infection.N Engl J Med. 2018; 378: 345-353Crossref PubMed Scopus (709) Google Scholar, 3Caldeira D Rodrigues B David C Costa J Pinto FJ Ferreira JJ The association of influenza infection and vaccine with myocardial infarction: systematic review and meta-analysis of self-controlled case series.Expert Rev Vaccines. 2019; 18: 1211-1217Crossref PubMed Scopus (28) Google Scholar Regarding myocardial infarction, as the investigators recognised, one of the possible limitations of this research is the inaccurate diagnosis and codification of myocardial injury or myocarditis as myocardial infarction, particularly because the current myocardial infarction definition (and diagnostic methods) differ from the definition at the time of the registry outcome validation study.4Thygesen K Alpert JS Jaffe AS et al.Fourth universal definition of myocardial infarction (2018).Glob Heart. 2018; 13: 305-338Crossref PubMed Scopus (178) Google Scholar In this context, we would like to stress that it is important to report either the risk estimates for ST-segment elevation myocardial infarction similarly to previous influenza studies,5Warren-Gash C Hayward AC Hemingway H et al.Influenza infection and risk of acute myocardial infarction in England and Wales: a CALIBER self-controlled case series study.J Infect Dis. 2012; 206: 1652-1659Crossref PubMed Scopus (144) Google Scholar or the risk of coronary revascularisation procedures after COVID-19, to decrease the potential bias and increase the robustness of the data and conclusions. We declare no competing interests. Risk of acute myocardial infarction and ischaemic stroke following COVID-19 in Sweden: a self-controlled case series and matched cohort studyOur findings suggest that COVID-19 is a risk factor for acute myocardial infarction and ischaemic stroke. This indicates that acute myocardial infarction and ischaemic stroke represent a part of the clinical picture of COVID-19, and highlights the need for vaccination against COVID-19. Full-Text PDF COVID-19 and myocardial infarction – Authors' replyWe thank Daniel Caldeira and Fausto Pinto for their comments regarding our study1 focusing on COVID-19 and myocardial infarction. We did acknowledge the difficulties in distinguishing between different types of myocardial injuries in the discussion. The International Classification of Diseases versions 9 and 10 unfortunately do not distinguish between ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI), which is a limitation of our study. Full-Text PDF