Clinical cardiovascular emergencies and the cellular basis of COVID-19 vaccination: from dream to reality?

Li, Yiran E.; Wang, Shuyi; Reíter, Russel J.; Ren, Jun

doi:10.1016/j.ijid.2022.08.026

Cited by 13 publications

(16 citation statements)

References 90 publications

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“…Full vaccination against COVID-19 has resulted in a reduced risk of AMI and ischemic stroke after COVID-19 infections. On the other hand, several studies have reported cardiovascular complications following COVID-19 vaccination which may range from asymptomatic myocardial injury to myocarditis, pericarditis, cardiac arrhythmias, and ACS [15–17]. These concerning findings were not supported by other studies that demonstrated a good safety profile of the BNT162b2 mRNA Covid-19 vaccine that was not associated with increased cardiovascular risk [18–20].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of patients with acute coronary syndrome according to COVID-19 vaccination status

Hilu,

Abu Ghosh,

Leibowitz

et al. 2023

Coronary Artery Disease

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Background COVID-19 vaccination has been associated with reduced risk of acute coronary syndrome (ACS); however, several studies have reported cardiovascular complications following vaccination. We aimed to investigate the effect of COVID-19 vaccination status on the treatment and outcome of ACS patients. Methods The study was based on the 2021 Acute Coronary Syndrome Israeli Survey. Patients were stratified into two groups according to COVID-19 vaccination status, vaccinated compared to unvaccinated. Patients who had received at least 2 vaccination doses up to 1 week prior to ACS hospitalization were considered vaccinated. The primary endpoint was 1-year all-cause mortality. Results A total of 1261 patients with ACS were included, of whom 990 (78.5%) were vaccinated. Vaccinated patients were older and less frequently smokers. There were no significant differences in coronary reperfusion rates and treatment with guideline-based medical therapy during hospital stay and at discharge. The primary endpoint of 1-year all-cause mortality occurred in 38 (3.8%) and 14 (5.2%) patients in the vaccinated and unvaccinated groups respectively (P = 0.42). 30-day MACE occurred in 94 (9.5%) in the vaccinated patients compared to 31 (11.5%) in the unvaccinated group (P = 0.39). These results remained similar following adjustment for confounders. Conclusion There was no association between COVID-19 vaccination status and the outcomes of patients with ACS. Our findings provide support for the cardiovascular safety of COVID-19 mRNA vaccines in patients at high cardiovascular risk.

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Section: Discussionmentioning

confidence: 99%

Outcomes of patients with acute coronary syndrome according to COVID-19 vaccination status

Hilu,

Abu Ghosh,

Leibowitz

et al. 2023

Coronary Artery Disease

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“…The most common clinical cardiac symptoms experienced following COVID-19 vaccination include tachycardia, shortness of breath, palpitations, chest pain, and hypertension [ 51 ]. Cardiac pathologies that have been reported in association with COVID-19 vaccination include myocardial infarction (MI), myocarditis, myopericarditis, ischemic heart disease, hypertension, acute coronary syndrome, arrhythmia, and cardiac arrest [ 53 ]. Myocarditis has been recognized as the most common coronavirus vaccine-related disease in young adults and adolescent males with reports indicating over 12.5 million cases in individuals aged 12–39 years [ 54 ].…”

Section: Adverse Hematological Effects Of Covid-19 Vaccination Within...mentioning

confidence: 99%

“…The male predominance of myocarditis may be related to sex hormone differences in immune response or an underdiagnosis of cardiac disease in women [ 55 ]. It has also been shown that there were more cases of cardiovascular and hematological complications in the 35–54 age group [ 59 ], with younger patients at a greater risk for cardiovascular complications following the second dose [ 53 ]. One study that looked at the rate of emergency medical service calls in Israel regarding MI and acute coronary syndromes (ACS) noted a 25% increase in the volume of the calls, which was strongly associated with the first and second doses of the mRNA vaccine rollout [ 63 ].…”

Section: Adverse Hematological Effects Of Covid-19 Vaccination Within...mentioning

confidence: 99%

Adverse Hematological Effects of COVID-19 Vaccination and Pathomechanisms of Low Acquired Immunity in Patients with Hematological Malignancies

et al. 2023

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The SARS-CoV-2 virus and the COVID-19 pandemic have spread across the world and severely impacted patients living with hematological conditions. Immunocompromised patients experience rapidly progressing symptoms following COVID-19 infection and are at high risk of death. In efforts to protect the vulnerable population, vaccination efforts have increased exponentially in the past 2 years. Although COVID-19 vaccination is safe and effective, mild to moderate side effects such as headache, fatigue, and soreness at the injection site have been reported. In addition, there are reports of rare side effects, including anaphylaxis, thrombosis with thrombocytopenia syndrome, Guillain-Barré Syndrome, myocarditis, and pericarditis after vaccination. Further, hematological abnormalities and a very low and transient response in patients with hematological conditions after vaccination raise concerns. The objective of this review is to first briefly discuss the hematological adverse effects associated with COVID-19 infection in general populations followed by critically analyzing the side effects and pathomechanisms of COVID-19 vaccination in immunocompromised patients with hematological and solid malignancies. We reviewed the published literature, with a focus on hematological abnormalities associated with COVID-19 infection followed by the hematological side effects of COVID-19 vaccination, and the mechanisms by which complications can occur. We extend this discussion to include the viability of vaccination efforts within immune-compromised patients. The primary aim is to provide clinicians with critical hematologic information on COVID-19 vaccination so that they can make informed decisions on how to protect their at-risk patients. The secondary goal is to clarify the adverse hematological effects associated with infection and vaccination within the general population to support continued vaccination within this group. There is a clear need to protect patients with hematological conditions from infection and modulate vaccine programs and procedures for these patients.

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“…A single-cell sequencing study [38] reported high expression levels of the viral ACE2 receptor in the CMs of normal hearts and that ACE2 expression is higher in the heart than in the lung of adults. In the absence of ACE2 in CMs, a crosstalk between angiotensin II (Ang II) and angiotensin-(1-7) (Ang- [1][2][3][4][5][6][7]) signaling may have more deleterious effects in the heart. The detrimental effect of ACE2 downregulation would inhibit the cardioprotective effects of Ang-(1-7), leading to increased TNF-α production [39,40] .…”

Section: Straight Cardiac Injury Tightly Associated With Ace2mentioning

confidence: 99%

“…There have been at least six million deaths led by the novel coronavirus disease 2019 (COVID-19) on a global scale [1] . Heart complications are among the most severe manifestations in patients with COVID-19 [2][3][4] .…”

Section: Introductionmentioning

confidence: 99%

Injury mechanism of COVID-19–induced cardiac complications

Leng

Bian

2023

Cardiology Plus

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Heart dysfunction is one of the most life-threatening organ dysfunctions caused by coronavirus disease 2019 (COVID-19). Myocardial or cardiovascular damage is the most common extrapulmonary organ complication in critically ill patients. Understanding the pathogenesis and pathological characteristics of myocardial and vascular injury is important for improving clinical diagnosis and treatment approach. Herein, the mechanism of direct damage caused by severe acute respiratory syndrome coronavirus 2 to the heart and secondary damage caused by virus-driven inflammation was reviewed. The pathological mechanism of ischemia and hypoxia due to microthrombosis and inflammatory injury as well as the injury mechanism of tissue inflammation and single myocardial cell necrosis triggered by the viral infection of pericytes or macrophages, hypoxia, and energy metabolism disorders were described. The latter can provide a novel diagnosis, treatment, and investigation strategy for heart dysfunctions caused by COVID-19 or the Omicron variant.

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Clinical cardiovascular emergencies and the cellular basis of COVID-19 vaccination: from dream to reality?

Cited by 13 publications

References 90 publications

Outcomes of patients with acute coronary syndrome according to COVID-19 vaccination status

Outcomes of patients with acute coronary syndrome according to COVID-19 vaccination status

Adverse Hematological Effects of COVID-19 Vaccination and Pathomechanisms of Low Acquired Immunity in Patients with Hematological Malignancies

Injury mechanism of COVID-19–induced cardiac complications

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