"Abstract
Background: The COVID-19 pandemic adversely affected the severity and prognosis of patients with acute myocardial infarction (MI) caused by atherothrombosis (type 1 MI)... Our aim was to analyze the association between the severity and outcome of patients with type 1 MI and their previous SARS-CoV2 vaccination and serostatus.
Methods: A single-center retrospective cohort study conducted between March 1, 2020 and March 1, 2023. Clinical and follow-up information was collected from medical records and patients. Total antibodies (IgM, IgA, IgG) to nucleocapsid (N) antigens were measured by ECLIA (electrochemiluminescence-based immunoassay) to test the immune response to natural infection. If positive, IgM and IgG antibodies to spike (S) surface antigens were measured by CLIA to test the immune response to vaccine or natural infection...
Results: Total sample of 949 patients, 656 with ST-segment elevation MI (STEMI) and 293 with non-ST-segment elevation MI (NSTEMI). Mean age was 64 (SD 13) years, 80 % men. Pre-admission vaccination status was: ≥ 1 dose, 53 % of patients; complete vaccination, 49 %; first booster dose, 25 %. The majority (84 %) of vaccines administered were mRNA-based. Six months after MI, 92 (9.7 %) patients had a major adverse cardiac event (MACE) and 50 died; 11 % of patients had severe heart failure or cardiogenic shock (Killip III-IV) after STEMI. Vaccinated patients with STEMI and positive serology (Pos/Vax group) had a higher risk of Killip III-IV on admission: OR 2.63 (1.27–5.44), p = 0.010. SARS-CoV-2 S-specific IgG titers were highest in this group (median > 2080 AU/mL, [IQR 1560- >2080] vs 91 [32–198] in the unvaccinated group)...
4. Discussion
The main finding of the present study was the association between post-infection SARS CoV-2 seropositivity in vaccinated patients and the development of severe heart failure and cardiogenic shock after STEMI...
Cases of MI have also been reported in association with vaccination against the SARS CoV-2 virus, although this association remains controversial. In a systematic review, Mani et al. note that MI was the most common type of arterial thrombosis (about 20 %) reported after SARS CoV-2 vaccination, followed by ischemic stroke. All but one of these myocardial infarctions were associated with the AstraZeneca vaccine...
Finally, it has been proposed that the thrombotic phenomenon after vaccination is caused by vaccine-induced thrombotic thrombocytopenia (VITT) as a possible mechanism, a condition related to heparin-induced thrombocytopenia (HIT). HIT is mediated by the generation of pathogenic antibodies against the heparin-PF4 complex, which releases more F4 from platelets and creates a hypercoagulable state. However, Cari et al. found that most venous thrombotic serious adverse events associated with the ChAdOx1 (Oxford/AstraZeneca) and Ad26.COV2·S (J&J) vaccines were not associated with thrombocytopenia, suggesting that VITT is not the only type of thrombosis observed after virus-based vaccines."
© 2024 The Authors. Published by Elsevier Ltd.
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