The association between influenza infection and acute myocardial infarction: A comprehensive systematic review and meta-analysis

Influenza infection could be associated with several systemic complications, including acute myocardial infarction (AMI); however, evidence on this association remains inconsistent. This systematic review and meta-analysis examined the influenza-AMI link, temporal AMI risk post-infection, and in-hos...

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Main Authors: Xia Zhou, Li Feng
Format: Article
Language:English
Published: Elsevier 2025-08-01
Series:Virus Research
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Online Access:http://www.sciencedirect.com/science/article/pii/S0168170225000711
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author Xia Zhou
Li Feng
author_facet Xia Zhou
Li Feng
author_sort Xia Zhou
collection DOAJ
description Influenza infection could be associated with several systemic complications, including acute myocardial infarction (AMI); however, evidence on this association remains inconsistent. This systematic review and meta-analysis examined the influenza-AMI link, temporal AMI risk post-infection, and in-hospital outcomes and mortality in influenza-infected AMI patients. We conducted a systematic search of PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science. Observational studies and self-controlled case series (SCCS) designs, were included. Data were extracted and analyzed using random-effects models to calculate pooled odds ratios (ORs), incidence rate ratios (IRRs), and 95 % confidence intervals (CIs). Subgroup analyses were performed based on exposure definitions (laboratory-confirmed influenza vs. influenza-like illness [ILI]), study design, and temporal patterns of AMI risk. In-hospital outcomes, including mortality, complications, length of stay, and costs, were also evaluated. The meta-analysis included 17 studies. A significant association was found, with a pooled adjusted OR of 2.70 (95 % CI: 1.28–5.72). ILI showed a stronger association with AMI (aOR: 2.04; 95 % CI: 1.33–3.14) compared to laboratory-confirmed influenza. Temporal analyses from SCCS studies revealed a markedly increased risk of AMI within the first week post-infection, peaking in days 1–3 (IRR: 6.83; 95 % CI: 4.66–10.01) and gradually declining thereafter. Influenza-infected AMI patients had significantly worse in-hospital outcomes, including higher mortality (OR: 1.60; 95 % CI: 1.55–1.66), and multiorgan failure (OR: 2.90; 95 % CI: 2.79–3.01). Additionally, these patients experienced longer median hospital stays (8.8 days vs. 5.5 days) and higher hospitalization costs ($20,678 vs. $18,269) compared to non-influenza AMI patients. This study confirms a strong link between influenza and AMI, especially early post-infection. Influenza-infected AMI patients experience worse outcomes, longer hospital stays, and higher costs. These findings highlight the importance of influenza prevention strategies, including vaccination, particularly in high-risk groups, to reduce AMI risk and its cardiovascular burden.
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spelling doaj-art-322a076583174830b3e40097fc93d4eb2025-08-20T03:31:23ZengElsevierVirus Research1872-74922025-08-0135819959410.1016/j.virusres.2025.199594The association between influenza infection and acute myocardial infarction: A comprehensive systematic review and meta-analysisXia Zhou0Li Feng1Department of Cardiovascular Medicine, People's Hospital of Chongqing Liangjiang New Area (Chongqing Medical University Affiliated Liangjiang Hospital), Chongqing, 401121, ChinaDepartment of Geriatrics, Danzishi Community Health Service Center, Nan 'an District, Chongqing, 400030, China; Corresponding author.Influenza infection could be associated with several systemic complications, including acute myocardial infarction (AMI); however, evidence on this association remains inconsistent. This systematic review and meta-analysis examined the influenza-AMI link, temporal AMI risk post-infection, and in-hospital outcomes and mortality in influenza-infected AMI patients. We conducted a systematic search of PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science. Observational studies and self-controlled case series (SCCS) designs, were included. Data were extracted and analyzed using random-effects models to calculate pooled odds ratios (ORs), incidence rate ratios (IRRs), and 95 % confidence intervals (CIs). Subgroup analyses were performed based on exposure definitions (laboratory-confirmed influenza vs. influenza-like illness [ILI]), study design, and temporal patterns of AMI risk. In-hospital outcomes, including mortality, complications, length of stay, and costs, were also evaluated. The meta-analysis included 17 studies. A significant association was found, with a pooled adjusted OR of 2.70 (95 % CI: 1.28–5.72). ILI showed a stronger association with AMI (aOR: 2.04; 95 % CI: 1.33–3.14) compared to laboratory-confirmed influenza. Temporal analyses from SCCS studies revealed a markedly increased risk of AMI within the first week post-infection, peaking in days 1–3 (IRR: 6.83; 95 % CI: 4.66–10.01) and gradually declining thereafter. Influenza-infected AMI patients had significantly worse in-hospital outcomes, including higher mortality (OR: 1.60; 95 % CI: 1.55–1.66), and multiorgan failure (OR: 2.90; 95 % CI: 2.79–3.01). Additionally, these patients experienced longer median hospital stays (8.8 days vs. 5.5 days) and higher hospitalization costs ($20,678 vs. $18,269) compared to non-influenza AMI patients. This study confirms a strong link between influenza and AMI, especially early post-infection. Influenza-infected AMI patients experience worse outcomes, longer hospital stays, and higher costs. These findings highlight the importance of influenza prevention strategies, including vaccination, particularly in high-risk groups, to reduce AMI risk and its cardiovascular burden.http://www.sciencedirect.com/science/article/pii/S0168170225000711InfluenzaAcute myocardial infarctionRiskOutcomeMeta-analysis
spellingShingle Xia Zhou
Li Feng
The association between influenza infection and acute myocardial infarction: A comprehensive systematic review and meta-analysis
Virus Research
Influenza
Acute myocardial infarction
Risk
Outcome
Meta-analysis
title The association between influenza infection and acute myocardial infarction: A comprehensive systematic review and meta-analysis
title_full The association between influenza infection and acute myocardial infarction: A comprehensive systematic review and meta-analysis
title_fullStr The association between influenza infection and acute myocardial infarction: A comprehensive systematic review and meta-analysis
title_full_unstemmed The association between influenza infection and acute myocardial infarction: A comprehensive systematic review and meta-analysis
title_short The association between influenza infection and acute myocardial infarction: A comprehensive systematic review and meta-analysis
title_sort association between influenza infection and acute myocardial infarction a comprehensive systematic review and meta analysis
topic Influenza
Acute myocardial infarction
Risk
Outcome
Meta-analysis
url http://www.sciencedirect.com/science/article/pii/S0168170225000711
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