Abstract
To investigate seasonality and association of increased enterovirus and influenza activity in the community with ventricular fibrillation (VF) risk during first ST-elevation myocardial infarction (STEMI). This study comprised all consecutive patients with first STEMI (n = 4,659; aged 18-80 years) admitted to the invasive catheterization laboratory between 2010-2016, at Copenhagen University Hospital, Rigshospitalet, covering eastern Denmark (2.6 million inhabitants, 45% of the Danish population). Hospital admission, prescription, and vital status data were assessed using Danish nationwide registries. We utilized monthly/weekly surveillance data for enterovirus and influenza from the Danish National Microbiology Database (2010-2016) that receives copies of laboratory tests from all Danish departments of clinical microbiology. Of the 4,659 consecutively enrolled STEMI patients, 581 (12%) had VF before primary percutaneous coronary intervention. In a subset (n = 807), we found that VF patients experienced more generalized fatigue and flu-like symptoms within 7 days before STEMI compared with the patients without VF (OR 3.39, 95% CI 1.76-6.54). During the study period, 2,704 individuals were diagnosed with enterovirus and 19,742 with influenza. No significant association between enterovirus and VF (OR 1.00, 95% CI 0.99-1.02), influenza and VF (OR 1.00, 95% CI 1.00-1.00), or week number and VF (p-value 0.94 for enterovirus and 0.89 for influenza) was found. We found no clear seasonality of VF during first STEMI. Even though VF patients had experienced more generalized fatigue and flu-like symptoms within 7 days before STEMI compared with patients without VF, no relationship was found between enterovirus or influenza exposure and occurrence of VF.
Highlights
The funders were not involved in any aspects of the study or the decision to submit for publication
We found no clear seasonality of ventricular fibrillation (VF) during first ST-elevation myocardial infarction (STEMI)
Even though VF patients had experienced more generalized fatigue and flu-like symptoms within 7 days before STEMI compared with patients without VF, no relationship was found between enterovirus or influenza exposure and occurrence of VF
Summary
Sudden cardiac death (SCD) caused by ventricular fibrillation (VF) during acute myocardial infarction (MI) is a major cause of cardiovascular mortality.[1,2,3] Susceptibility to VF during acute ischemia is undoubtedly multifactorial and modulated by several factors, including autonomic dysregulation, electrolyte disturbance, hemodynamic dysfunction, inherited factors, and various environmental influences.[1,4,5]Seasonal variation has been reported in the incidence of sudden cardiac arrest (SCA) and sudden death/SCD,[6,7,8,9,10] typically with a winter peak and a summer nadir. Exposure to cold weather is considered the main factor influencing this seasonality.[7] these previous epidemiological studies are limited by differences in the definition of SCD (none had VF recording available) used and the fact that they often included SCD cases occurring in the setting of different cardiac pathologies (i.e., etiological heterogeneity in substrate for VF). These seasonal patterns indicate the presence of seasonal external factors, such as viral infections, that could trigger VF. Several studies have shown that influenza vaccine protects against acute MI and heart failure.[21,22,23] In addition, because EV and influenza epidemics can be accurately and reliably forecast, such forecasts could advise individuals with chest pain and flu-like symptoms to seek medical care in an early phase during outbreaks
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