Abstract
Gastroenteritis promotes the development of systemic inflammation and a hypercoagulable state. There are limited data regarding the association between gastroenteritis and acute myocardial infarction (AMI). We aimed to evaluate the risk of AMI after an episode of gastroenteritis. In this nested case-control study, we selected patients who were hospitalized for AMI (N = 103,584) as a case group during 2010–2017 and performed propensity score matching (case-control ratio 1:1) to select eligible controls from insurance research data in Taiwan. We applied multivariable logistic regressions to calculate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for the risk of AMI associated with recent gastroenteritis within 14 days before AMI. We also compared the outcomes after AMI in patients with or without gastroenteritis. A total of 1381 patients (1.3%) with AMI had a prior episode of gastroenteritis compared to 829 (0.8%) among the controls. Gastroenteritis was significantly associated with a subsequent risk of AMI (adjusted OR: 1.68, 95% CI: 1.54–1.83), which was augmented in hospitalizations for gastroenteritis (adjusted OR: 2.50, 95% CI: 1.20–5.21). The outcomes after AMI were worse in patients with gastroenteritis than in those without gastroenteritis, including increased 30-day in-hospital mortality (adjusted OR: 1.28, 95% CI: 1.08–1.52), medical expenditure, and length of hospital stay. Gastroenteritis may act as a trigger for AMI and correlates with worse post-AMI outcomes. Strategies of aggressive hydration and/or increased antithrombotic therapies for this susceptible population should be further developed.
Highlights
Recent gastroenteritis infection was associated with acute myocardial infarction (AMI) in men, women, and people aged 20–49 years
This study demonstrated that gastroenteritis was significantly associated with a subsequent risk of AMI, which was further augmented in patients with gastroenteritis requiring hospitalizations
The outcomes after AMI were worse in patients with gastroenteritis than in those without gastroenteritis, including increased in-hospital mortality, medical expenditure, and length of hospital stay
Summary
Ischemic heart disease remains a leading cause of mortality and morbidity, accounting for approximately 10 million annual cases of myocardial infarction and causing a substantial creativecommons.org/licenses/by/ 4.0/). Acute myocardial infarction (AMI) is triggered by a variety of factors, including physical exertion [4,5], emotional stress [4,5], respiratory infection [6–12], and a hypercoagulable state [13]. Gastroenteritis has caused a global epidemic, affecting approximately 6 billion people and leading to 1.5 million deaths globally in 2017 [1,2]. Severe dehydration predisposes patients to venous thromboembolism, which has been reported in those with ischemic stroke and marathon athletes [17,18]. Gastroenteritis promotes the development of systemic inflammation and a hypercoagulable state; these complications may contribute to the pathogenesis of coronary artery thrombosis [13,14]. An epidemiological survey showed that bacterial gastroenteritis may elevate the risk of hypertension and cardiovascular diseases [19]. Limited information is available on the association between gastroenteritis and the risk of AMI
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