Risk of Acute Myocardial Infarction Following Invasive Pneumococcal Disease: How Much Is Due to Antibiotic Treatments?

Abstract

To the Editor—We studied with interest the article by Wiese et al [1] that found a significant association between hospitalization due to acute myocardial infarction (AMI) and laboratory-confirmed invasive pneumococcal disease (IPD). The authors included 324 patients hospitalized for a first-time AMI between 2003 and 2019. Follow-ups were started 1 year before the AMI date and continued to the date of death, 1 year after the AMI date, or end of the study (December 2019). The date of IPD detection was considered as “date 0,” and the follow-up period was divided into 4 shorter risk periods: pre-IPD (days −7 to −1), current IPD (days 0–7), post-IPD (days 8–28), and a control period (all other follow-up time). Compared to the control period, the incidence of AMI was significantly higher during pre-IPD (incidence rate ratio [IRR], 10 [95% confidence interval {CI}, 6.3–17]) and current IPD (IRR, 93 [95% CI, 72–120]) but nonsignificantly elevated in the post-IPD (IRR, 1.8 [95% CI, .86–3.9]) risk period [1]. Interestingly, the frequency of hospitalizations due to AMI peaked on the day before or the same day the microbiologic specimens were collected. Furthermore, >85% of the IPD cases were identified around the AMI hospitalization day. The strong association between AMI and IPD is important, especially because some IPDs are potentially vaccine preventable.