Respiratory Viral Contribution to Acute Myocardial Infarction in Victoria: 13-Year Time Series and Spatiotemporal Analysis

Aim Common infections can trigger acute myocardial infarction (AMI), but the proportion of AMI events that may be attributable to specific respiratory viruses is unclear. We aimed to examine the incidence of AMI associated with respiratory viral triggers and to estimate the attributable fraction at a population level. Method We analysed independent statewide hospital admissions and laboratory datasets in Victoria, Australia, from 2010 to 2022. Time-series analysis consisted of generalised additive distributed lag non-linear modelling to analyse the temporal association between weekly respiratory virus levels and AMI counts, and to compute attributable fractions. Bayesian hierarchical modelling was used to explore spatiotemporal variation in respiratory viruses-associated AMI. Results This study included 164,283 AMI hospital admissions and 6,180,896 laboratory specimens. An increase in respiratory virus detection rate was significantly associated with higher AMI incidence (incidence rate ratio: 1.0041; 95% CI: 1.0015–1.0067) after adjusting for seasonality, cold temperature, and fine particulate matter air pollution. An estimated 8.7% of all AMI events may be attributable to respiratory viral triggers, constituting an average annual incidence of 16.2 per 100,000. We found significant associations with specific respiratory viruses and fractions of AMI attributable to enterovirus (5.2%), influenza (1.5%), and respiratory syncytial virus (0.9%), with figures increased during peak viral seasons. Spatiotemporal analysis revealed higher incidence rate ratios in outer-metropolitan regions. Conclusions Respiratory viral triggers contribute to the incidence of AMI. Population-level infection prevention strategies, such as vaccination, may reduce the impact of respiratory outbreaks during peak seasons.