Blasco Ana, Royuela Ana, García-Gómez Sergio, Gómez-Lozano Natalia, Sánchez-Arjona Alberto, de la Fuente Jorge, Anel Jorge, Sánchez-Galarraga Icíar, Pérez-Redondo Marina, González Elisa, Silva Lorenzo
Cardiology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain; Research Ethics Committee, Instituto de Investigación Puerta de Hierro-Segovia de Arana, Madrid, Spain.
Biostatistics Unit, Instituto de Investigación Puerta de Hierro-Segovia de Arana, Madrid, Spain; Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP), Madrid, Spain.
Vaccine. 2024 Dec 2;42(26):126305. doi: 10.1016/j.vaccine.2024.126305. Epub 2024 Sep 7.
The COVID-19 pandemic adversely affected the severity and prognosis of patients with acute myocardial infarction (MI) caused by atherothrombosis (type 1 MI). The effect, if any, of COVID-19 vaccination and natural SARS-CoV2 serologic immunity in these patients is unclear. 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.
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. Multivariable logistic regression analysis was performed, adjusting for age, sex, hypertension, diabetes, and dyslipidemia.
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). In the overall sample, a higher incidence of 6-month MACE was not demonstrated (OR 1.89 [0.98-3.61], p = 0.055).
The combination of vaccination and natural SARS-CoV2 infection was associated with the development of severe heart failure and cardiogenic shock in patients with STEMI, possibly related to an increased serological response.
新型冠状病毒肺炎（COVID-19）大流行对动脉粥样硬化血栓形成所致急性心肌梗死（MI，1型MI）患者的病情严重程度和预后产生了不利影响。目前尚不清楚COVID-19疫苗接种和自然感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）产生的血清学免疫力对这些患者是否有影响。我们的目的是分析1型MI患者的病情严重程度和预后与既往SARS-CoV-2疫苗接种情况及血清状态之间的关联。
一项单中心回顾性队列研究，研究时间为2020年3月1日至2023年3月1日。从病历和患者处收集临床及随访信息。采用电化学发光免疫分析法（ECLIA）检测针对核衣壳（N）抗原的总抗体（IgM、IgA、IgG），以检测对自然感染的免疫反应。如果结果为阳性，则采用化学发光免疫分析法（CLIA）检测针对刺突（S）表面抗原的IgM和IgG抗体，以检测对疫苗或自然感染的免疫反应。进行多变量逻辑回归分析，并对年龄、性别、高血压、糖尿病和血脂异常进行校正。
共纳入949例患者，其中656例为ST段抬高型心肌梗死（STEMI），293例为非ST段抬高型心肌梗死（NSTEMI）。平均年龄为64（标准差13）岁，男性占80%。入院前疫苗接种情况为：≥1剂，占患者的53%；全程接种，占49%；首次加强剂量，占25%。所接种的疫苗大多数（84%）为信使核糖核酸（mRNA）疫苗。心肌梗死后6个月，92例（9.7%）患者发生主要不良心脏事件（MACE），50例死亡；11%的STEMI患者发生严重心力衰竭或心源性休克（Killip III-IV级）。STEMI且血清学检测呈阳性的接种患者（阳性/接种组）入院时发生Killip III-IV级的风险更高：比值比（OR）为2.
