Cardiovascular Toxicology

, Volume 19, Issue 2, pp 147–155 | Cite as

Risk of Myocardial Infarction After Carbon Monoxide Poisoning: A Nationwide Population-Based Cohort Study

  • Chien-Cheng Huang
  • Chung-Han Ho
  • Yi-Chen Chen
  • Hung-Jung Lin
  • Chien-Chin Hsu
  • Jhi-Joung Wang
  • Shih-Bin Su
  • How-Ran GuoEmail author


Carbon monoxide poisoning (COP) may lead to ischemic changes in organs, and heart is one of the most susceptible targets to ischemic condition. The objective of this study is to evaluate the risk of myocardial infarction following COP. Using a nationwide database of insurance claims in Taiwan, we conducted a population-based cohort study to identify COP patients diagnosed between 1999 and 2012. At a ratio of 3:1, we identified non-COP patients who were matched by the index date and age and compared the risk of myocardial infarction between the two cohorts by time after the index dates of the COP patients, until 2013. We identified 22,258 COP patients and 66,774 non-COP patients. COP patients had an increased risk of myocardial infarction, with an incidence rate ratio of 1.45 (95% confidence interval 1.06–1.98) in comparison with the non-COP patients after adjusting for other independent predictors, including older age, male sex, and underlying comorbidity of hypertension, diabetes, and renal disease. Stratified analyses showed that the increased risk was more prominent in patients with a young age (< 34 years), female sex, and liver disease, and occurred only in the first month of follow-up. We concluded that COP increased the risk of myocardial infarction, but the increased risk was only observed in the first month after COP, which indicated that the impact of COP on the heart was mainly acute. Patients who were younger than 34 years, female, and with liver diseases were more prone to myocardial infarction after COP.


Carbon monoxide Heart Myocardial infarction Myocardial injury Poisoning 



Carbon monoxide poisoning


Carbon monoxide


Nationwide Poisoning Database


Longitudinal Health Insurance Database 2000


Coronary artery disease


International Classification of Diseases-9


Human immunodeficiency virus


New Taiwan Dollars


Incidence rate ratios


Confidence interval


Adjusted hazard ratio


Hyperbaric oxygen therapy


Author contributions

C-C Huang and H-RG designed and conceived this study and wrote the manuscript. H-CH and Y-CC performed the statistical analysis and wrote the manuscript. H-JL, C-C Hsu, J-JW, and S-BS provided professional suggestions and wrote the manuscript. All the authors have read and approved the final manuscript.


This study was supported by Grants CMFHR10677 and CMFHR10734 from the Chi-Mei Medical Center.

Compliance with Ethical Standards

Conflict of interest

The authors declare no potential conflicts of interest.

Ethical Approval

This study involved human data and was conducted in strict accordance with the Declaration of Helsinki. The study protocol was approved by the Institutional Review Board (IRB) at the Chi-Mei Medical Center.

Informed Consent

The two databases consisted of depersonalized information, and so the requirement of informed consent was waived by the IRB as the study did not affect the welfare of the participants.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Emergency MedicineChi-Mei Medical CenterTainanTaiwan
  2. 2.Department of Environmental and Occupational Health, College of MedicineNational Cheng Kung UniversityTainanTaiwan
  3. 3.Department of Senior ServicesSouthern Taiwan University of Science and TechnologyTainanTaiwan
  4. 4.Department of Geriatrics and GerontologyChi-Mei Medical CenterTainanTaiwan
  5. 5.Department of Occupational MedicineChi-Mei Medical CenterTainanTaiwan
  6. 6.Department of Medical ResearchChi Mei Medical CenterTainanTaiwan
  7. 7.Department of PharmacyChia Nan University of Pharmacy and ScienceTainanTaiwan
  8. 8.Department of BiotechnologySouthern Taiwan University of Science and TechnologyTainanTaiwan
  9. 9.Department of Emergency MedicineTaipei Medical UniversityTaipeiTaiwan
  10. 10.Department of Leisure, Recreation and Tourism ManagementSouthern Taiwan University of Science and TechnologyTainanTaiwan
  11. 11.Department of Medical ResearchChi-Mei Medical CenterTainanTaiwan
  12. 12.Department of Occupational and Environmental MedicineNational Cheng Kung University HospitalTainanTaiwan

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