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

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Abstract

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.

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Abbreviations

COP:

Carbon monoxide poisoning

CO:

Carbon monoxide

NPD:

Nationwide Poisoning Database

LHID2000:

Longitudinal Health Insurance Database 2000

CAD:

Coronary artery disease

ICD-9:

International Classification of Diseases-9

HIV:

Human immunodeficiency virus

NTD:

New Taiwan Dollars

IRR:

Incidence rate ratios

CI:

Confidence interval

AHR:

Adjusted hazard ratio

HBOT:

Hyperbaric oxygen therapy

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Funding

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

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan

    Chien-Cheng Huang, Hung-Jung Lin & Chien-Chin Hsu

  2. Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 1 Daxue Road, East District, Tainan City 701, Tainan, Taiwan

    Chien-Cheng Huang & How-Ran Guo

  3. Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan

    Chien-Cheng Huang

  4. Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan

    Chien-Cheng Huang

  5. Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan

    Chien-Cheng Huang & Shih-Bin Su

  6. Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan

    Chung-Han Ho, Yi-Chen Chen & Jhi-Joung Wang

  7. Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan

    Chung-Han Ho

  8. Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan

    Hung-Jung Lin & Chien-Chin Hsu

  9. Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan

    Hung-Jung Lin

  10. Department of Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan

    Shih-Bin Su

  11. Department of Medical Research, Chi-Mei Medical Center, Liouying, Tainan, Taiwan

    Shih-Bin Su

  12. Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan

    How-Ran Guo

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  1. Chien-Cheng Huang
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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.

Corresponding author

Correspondence to How-Ran Guo.

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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.

Additional information

Handling Editor: Gen Suzuki.

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Huang, CC., Ho, CH., Chen, YC. et al. Risk of Myocardial Infarction After Carbon Monoxide Poisoning: A Nationwide Population-Based Cohort Study. Cardiovasc Toxicol 19, 147–155 (2019). https://doi.org/10.1007/s12012-018-9484-9

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  • DOI: https://doi.org/10.1007/s12012-018-9484-9

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