Risk of Myocardial Infarction and Stroke after a First Episode of Acute Pancreatitis: A Self-Controlled Case Series Study.

Objectives: Acute pancreatitis induces systemic inflammation and promotes a prothrombotic environment, which may increase the risk of cardiovascular events. However, the temporal relationship between acute pancreatitis and subsequent cardiovascular events remains unexplored. We aimed to examine whether the risk of acute myocardial infarction and stroke is increased following an episode of acute pancreatitis.

Methods: We conducted a Danish Nationwide population-based cohort study, including all incident cases of acute pancreatitis (≥18 years) from 2002 to 2017. The primary outcome was acute myocardial infarction or stroke. Using a self-controlled case series design, we compared the incidence of myocardial infarction or stroke during a risk interval (90 days following acute pancreatitis discharge) with two control intervals (365 days before and 91-365 days after the acute pancreatitis episode).

Results: Among 33,124 patients with incident acute pancreatitis, 366 cases of myocardial infarction and 624 cases of stroke were identified within one year of the acute pancreatitis episode. The incidence rate ratios (IRR) for myocardial infarction during the 90-day risk interval was 1.87 (95% confidence interval (CI), 1.42-2.47), with the highest risk observed during the first 10 days (IRR, 4.08; 95% CI, 2.58-6.44), followed by a gradual decline. The IRR for stroke during the risk interval was 2.12 (95% CI, 1.74-2.58), peaking in the first 10 days (IRR, 3.40; 95% CI, 2.33-4.96) and gradually declining.

Conclusions: Our study reveals a temporary increase in the risk of myocardial infarction and stroke after hospitalization for a first episode of acute pancreatitis.