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Boker LK, Fluss R, Dichtiar R, Rosenberg A, Ben-Lassan M, Huppert A. Pfizer COVID19 vaccine is not associated with acute cardiovascular events excluding myocarditis- a national self-controlled case series study. Isr J Health Policy Res 2024; 13:23. [PMID: 38659032 PMCID: PMC11040923 DOI: 10.1186/s13584-024-00609-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 04/07/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Despite publications assuring no increased risk for acute cardiovascular events (excluding myocarditis) and sudden death following administration of COVID19 vaccines, these issues still stir much public ado. We assessed the risk for acute cardiovascular events that require hospitalization (excluding myocarditis) and for mortality in the short-term following administration of the second dose of the Pfizer COVID19 vaccine in Israel. METHODS Using a self-controlled case series (SCCS) study design and national databases, all second-dose vaccinees, who had not been diagnosed with COVID19 and who had an acute cardiovascular event (acute myocardial infarction/acute stroke/acute thromboembolic event) that required hospitalization in the 60 days following vaccine administration between Jan 11th, 2021 and Oct 31st 2021, were included. A similar analysis was carried out for mortality. The first 30 days following vaccination were defined as risk period while the next 30 days were defined as control period. The probability for an event between these periods was compared using a conditional logistic regression model, accounting for sex, age group, background morbidity and seasonal risk. RESULTS Out of 5,700,112 second dose vaccinees, 4,163 had an acute cardiovascular event in the 60 days following vaccine administration. Following exclusion of 106 due to technical considerations, 1,979 events occurred during the risk period and 2,078 during the control period: Odds ratio, OR = 0.95, 95% confidence interval, CI 0.90-1.01, p = 0.12. Adjusted OR was similar (OR = 0.88, 95%CI 0.72-1.08). Stratifying by age showed no increased risk in any age group. Mortality assessment indicated low number of events in both periods. These results were consistent in sensitivity analyses. CONCLUSIONS There was no increased risk for acute cardiovascular events (excluding myocarditis) in the risk period compared to the control period following administration of the second dose of Pfizer COVID19 vaccine. Mortality data raised no concerns either, but may have been biased.
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Affiliation(s)
- Lital Keinan Boker
- Israel Center for Disease Control, Ministry of Health, Sheba Medical Center, Gertner bldg, 52621, Tel Hashomer, Ramat Gan, Israel.
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
| | - Ronen Fluss
- Gertner Institute for the Study of Epidemiology and Health Policy, Sheba Medical Center, Ramat Gan, Israel
| | - Rita Dichtiar
- Israel Center for Disease Control, Ministry of Health, Sheba Medical Center, Gertner bldg, 52621, Tel Hashomer, Ramat Gan, Israel
| | - Alina Rosenberg
- Israel Center for Disease Control, Ministry of Health, Sheba Medical Center, Gertner bldg, 52621, Tel Hashomer, Ramat Gan, Israel
| | - Maya Ben-Lassan
- Israel Center for Disease Control, Ministry of Health, Sheba Medical Center, Gertner bldg, 52621, Tel Hashomer, Ramat Gan, Israel
| | - Amit Huppert
- Gertner Institute for the Study of Epidemiology and Health Policy, Sheba Medical Center, Ramat Gan, Israel
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Paratz ED, Fahy L, Stub D, Nehme Z, Connell V, Pflaumer A, La Gerche A. Diversity of ICD-10 coding for sudden arrhythmic death syndrome is likely to create a spurious rise in cases under new ICD-11 nomenclature. Heart Rhythm 2024:S1547-5271(24)02513-X. [PMID: 38670248 DOI: 10.1016/j.hrthm.2024.04.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Affiliation(s)
- Elizabeth D Paratz
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; St Vincent's Institute of Medical Research, Fitzroy, Victoria, Australia; Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, Victoria, Australia; Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia.
| | - Louise Fahy
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; St Vincent's Institute of Medical Research, Fitzroy, Victoria, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia; Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ziad Nehme
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Centre for Research & Evaluation, Ambulance Victoria, Blackburn, North Victoria, Australia
| | - Vanessa Connell
- Department of Cardiology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Andreas Pflaumer
- Department of Cardiology, Royal Children's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Andre La Gerche
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; St Vincent's Institute of Medical Research, Fitzroy, Victoria, Australia; Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
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De Gaspari M, Fedeli U, Saia M, Carturan E, Pilichou K, Corrado D, Thiene G, Rizzo S, Basso C. Rate and Cause of Sudden Cardiac Death in the Young During the COVID-19 Pandemic and Vaccination. Circulation 2023; 148:2069-2071. [PMID: 38109343 PMCID: PMC10752257 DOI: 10.1161/circulationaha.123.066270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Affiliation(s)
- Monica De Gaspari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua - Azienda Ospedaliera, Padova, Italy (M.D.G., E.C., K.P., D.C., G.T., S.R.)
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Italy (U.F.)
| | - Mario Saia
- Clinical Governance Unit, Azienda Zero, Veneto Region, Italy (M.S.)
| | - Elisa Carturan
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua - Azienda Ospedaliera, Padova, Italy (M.D.G., E.C., K.P., D.C., G.T., S.R.)
| | - Kalliopi Pilichou
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua - Azienda Ospedaliera, Padova, Italy (M.D.G., E.C., K.P., D.C., G.T., S.R.)
| | - Domenico Corrado
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua - Azienda Ospedaliera, Padova, Italy (M.D.G., E.C., K.P., D.C., G.T., S.R.)
| | - Gaetano Thiene
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua - Azienda Ospedaliera, Padova, Italy (M.D.G., E.C., K.P., D.C., G.T., S.R.)
| | - Stefania Rizzo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua - Azienda Ospedaliera, Padova, Italy (M.D.G., E.C., K.P., D.C., G.T., S.R.)
| | - Cristina Basso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua - Azienda Ospedaliera, Padova, Italy (M.D.G., E.C., K.P., D.C., G.T., S.R.)
- Epidemiological Department, Azienda Zero, Veneto Region, Italy (U.F.)
- Clinical Governance Unit, Azienda Zero, Veneto Region, Italy (M.S.)
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Stowe J, Whitaker HJ, Andrews NJ, FMedSci EM. Risk of cardiac arrhythmia and cardiac arrest after primary and booster COVID-19 vaccination in England: A self-controlled case series analysis. Vaccine X 2023; 15:100418. [PMID: 38090643 PMCID: PMC10714224 DOI: 10.1016/j.jvacx.2023.100418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 02/08/2024] Open
Abstract
Background Various cardiac arrhythmias have been reported after COVID-19 infection and vaccination. We assessed the risk after primary immunisation with the ChAdOx1 adenovirus vectored vaccine, and primary and booster immunisation with an mRNA vaccine in 40 million vaccinated adults with 121 million doses (33.9% ChAdOx1 and 66.1% mRNA) in England. Methods Hospital admissions for a cardiac arrhythmia and emergency care attendance for a cardiac arrest in individuals aged 18 years and older on the 31st March 2021 were linked to the national COVID-19 immunisation register. The incidence of events 1-14 and 15-28 days after vaccination relative to a post-vaccination control period was estimated using the self-controlled case series method modified for fatal events. Outcomes were stratified by arrhythmia type, vaccine type, age group and dose number (up to five). Elevated relative incidence (RI) estimates with p < 0.001 were considered strong evidence of an association. Findings There was an increased risk of admission for arrhythmia events that were largely palpitations without myocarditis within 14 days of a second priming dose of an mRNA vaccine in 18-49 year olds with an RI of 1.66 (95 % confidence interval 1.47,1.86) for BNT162b2 and 3.75 (2.52,5.57) for mRNA-1273 (p < 0.001) and also after a first booster dose, 1.34 (1.17,1.53) and 1.75 (1.43,2.15) respectively (p < 0.001). No other cardiac arrhythmia, including cardiac arrest, showed an elevated incidence within 28 days of vaccination for any dose, age group or vaccine type. In contrast the risk of a cardiac arrhythmia of all types, including a cardiac arrest, was consistently elevated in those testing positive for SARS-CoV-2 infection. Interpretation Our study provides reassuring evidence of the safety of the ChAdOx1 and mRNA COVID-19 vaccines with respect to serious cardiac arrhythmias and of the favourable risk benefit of mRNA booster vaccination.
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Affiliation(s)
- Julia Stowe
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EU, United Kingdom
| | - Heather J. Whitaker
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EU, United Kingdom
| | - Nick J. Andrews
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EU, United Kingdom
| | - Elizabeth Miller FMedSci
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK
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Maruyama T, Uesako H. Lessons Learnt from Case Series of Out-of-hospital Cardiac Arrest and Unexpected Death after COVID-19 Vaccination. Intern Med 2023; 62:3267-3275. [PMID: 37612082 DOI: 10.2169/internalmedicine.2298-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Vaccination against COVID-19 has raised concerns about myocarditis in young men, as out-of-hospital cardiac arrest (OHCA) or sudden death after vaccination has been reported sporadically. Common features of these cases are occurrence in young men, within a few weeks after vaccination, in patients with no structural heart diseases. Cases of unexplained nocturnal death showed fibrotic or hypertrophied myocardium, and one case of OHCA presented ventricular fibrillation (VF) triggered by a prominent J wave on an automated external defibrillator and histopathologic findings compatible with myocarditis. Both myocarditis and J waves are prevalent in young men, and these cases imply that myocarditis augments J waves, which trigger VFs, and primary electrical disorders are a leading cause of death. To prevent such issues, artificial intelligence (AI)-assisted interpretation of historical electrocardiogram findings may help predict future J wave formation leading to VF, as digital electrocardiogram (ECG) findings are well suited for AI interpretation.
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Affiliation(s)
- Toru Maruyama
- Professor Emeritus in Kyushu University, Kyushu University Hospital, Japan
- Haradoi Hospital, Japan
| | - Hayata Uesako
- Department of Internal Medicine, Suwa Central Hospital, Japan
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Daems JJN, van Hattum JC, Verwijs SM, Bijsterveld NR, Groenink M, Wilde AAM, Pinto YM, Jorstad HT. Cardiac sequelae in athletes following COVID-19 vaccination: evidence and misinformation. Br J Sports Med 2023; 57:1400-1402. [PMID: 37562938 DOI: 10.1136/bjsports-2023-106847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/12/2023]
Abstract
The recognition of myocarditis as a rare side effect of SARS-CoV-2 mRNA vaccination has sparked a global debate on vaccine safety, especially in the realm of sports. The main proposed mechanisms in the pathogenesis of COVID-19 mRNA vaccination-associated myocarditis (C-VAM) are based on the activation of the innate- and adaptive immune system against a susceptible immune-genetic background, including the recognition of mRNA as an antigen by the immune system, molecular mimicry between SARS-CoV-2 spike glycoprotein and cardiac tissue antigens and inflammatory sex-hormone signalling. The relatively younger age of the athlete population hypothetically constellates an increased risk of C-VAM. A subgroup analysis in individuals under 40 years revealed a low incidence of myocarditis following COVID-19 mRNA vaccination when compared to positive SARS-CoV-2 tests. No confirmed cases of athletes experiencing cardiac complications after mRNA vaccination have been reported. Most athletes only reported mild side effects after COVID-19 vaccination. A small but statistically significant decrease in maximal oxygen consumption in recreational athletes occurred after BNT162b2 mRNA booster vaccine administration. The clinical relevance and temporality of which remain to be determined. Many speculative social media reports attribute sudden cardiac arrest/death (SCA/D) in athletes to mRNA vaccination. Large media outlets have thoroughly debunked these claims. There is currently no evidence to support the claim that COVID-19 mRNA vaccination increases the risk of myocardial sequelae or SCA/D in athletes. However, specific vaccine regimen selection and timing may be appropriate to prevent detrimental performance effects.
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Affiliation(s)
| | | | - Sjoerd M Verwijs
- Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Nick R Bijsterveld
- Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Maarten Groenink
- Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Yigal M Pinto
- Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Harald T Jorstad
- Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
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