Acute COVID-19 and the incidence of ischemic stroke and acute myocardial infarction

D Modin, B Claggett, C Sindet-Pedersen… - Circulation, 2020 - Am Heart Assoc
D Modin, B Claggett, C Sindet-Pedersen, MCH Lassen, KG Skaarup, JUS Jensen, M Fralick…
Circulation, 2020Am Heart Assoc
CORRESPONDENCE of COVID-19; 3174 (62%) had received an outpatient diagnosis.
Among this population, 44 patients had firstever ischemic stroke during the observation
period. The mean age of the study population was 77 years (SD 9) and 52% were male. A
total of 6 patients had diabetes (15%), 20 had hypertension (45%), and 15 had dyslipidemia
(34%). Eleven patients had an outpatient diagnosis of COVID-19 (25%); 33 patients
received an inpatient diagnosis of COVID-19 (75%). A total of 18 strokes occurred during the …
CORRESPONDENCE of COVID-19; 3174 (62%) had received an outpatient diagnosis. Among this population, 44 patients had firstever ischemic stroke during the observation period. The mean age of the study population was 77 years (SD 9) and 52% were male. A total of 6 patients had diabetes (15%), 20 had hypertension (45%), and 15 had dyslipidemia (34%). Eleven patients had an outpatient diagnosis of COVID-19 (25%); 33 patients received an inpatient diagnosis of COVID-19 (75%). A total of 18 strokes occurred during the 14-day risk interval. The incidence of ischemic stroke was≈ 10 times higher during the 14 days after COVID-19 diagnosis (Table) as compared with the control interval. The incidence of ischemic stroke remained statistically significantly elevated when the risk interval was extended to 21 and 31 days after COVID-19 diagnosis (Table). The results remained robust in all sensitivity analyses (Table). Of the 5119 patients diagnosed with COVID-19, 17 patients had first-ever AMI during the observation period. The mean age of the population was 73 years (SD 13), and 53% were male. Fewer than 4 patients had diabetes, 11 patients had dyslipidemia (65%), and< 4 patients had hypertension. The majority of patients had an inpatient diagnosis of COVID-19, and< 4 patients had an outpatient diagnosis. A total of 4 AMIs occurred during the risk interval. The incidence of AMI was≈ 5 times higher during the 14 days after COVID-19 diagnosis (Table) as compared with the control interval. When the risk interval was extended to 21 days and 31 days after COVID-19 diagnosis, the incidence of AMI remained statistically significantly elevated as compared with the control interval (Table). The results were robust throughout all sensitivity analyses (Table). Our findings extend those of previous reports1–4 and provide evidence that COVID-19 may increase the risk of ischemic cardiovascular events. Similar to other acute infections, the underlying mechanisms may include cytokine-mediated plaque destabilization and hypercoagulability. Our study is limited by the low number of cases, which is likely the result of the low burden of infection observed in Denmark during the study period.
Am Heart Assoc