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Risk for MI, Stroke, Pulmonary Embolism After COVID-19 Vaccines
Quick Takes
- There was no evidence of an association between the mRNA-based Pfizer–BioNTech or Moderna vaccines and acute MI, stroke, or pulmonary embolism (PE) in the 3 weeks after each of the first two doses.
- There was a slight increase in risk for PE with the Oxford–AstraZeneca vaccine and for acute MI with the two adenoviral-based vaccines (Oxford–AstraZeneca and Janssen).
- Vaccination, including with adenoviral-based vaccines, could also decrease risk for a cardiovascular event by limiting the consequences of a potential SARS-CoV-2 infection and be overall beneficial.
Study Questions:
What is the short-term risk for severe cardiovascular events (excluding myocarditis and pericarditis) after coronavirus disease 2019 (COVID-19) vaccination in France’s 46.5 million adults younger than 75 years?
Methods:
The investigators conducted a self-controlled case series method adapted to event-dependent exposure and high event-related mortality in France, from December 27, 2020–July 20, 2021. All adults younger than 75 years hospitalized for pulmonary embolism (PE), acute MI, hemorrhagic stroke, or ischemic stroke (n = 73,325 total events) during this time were included. Linkage between the French National Health Data System and COVID-19 vaccine databases enabled identification of hospitalizations for cardiovascular events (MI, PE, or stroke) and receipt of a first or second dose of the Pfizer–BioNTech, mRNA-1273 (Moderna), Ad26.COV2.S (Janssen), or ChAdOx1 nCoV-19 (Oxford–AstraZeneca) vaccine. The relative incidence (RI) of each cardiovascular event was estimated in the 3 weeks after vaccination compared with other periods, with adjustment for temporality (7-day periods).
Results:
No association was found between the Pfizer–BioNTech or Moderna vaccine and severe cardiovascular events. The first dose of the Oxford–AstraZeneca vaccine was associated with acute MI and PE in the second week after vaccination (RI, 1.29 [95% CI, 1.11-1.51] and 1.41 [95% CI, 1.13-1.75], respectively). An association with MI in the second week after a single dose of the Janssen vaccine could not be ruled out (RI, 1.75 [95% CI, 1.16-2.62]).
Conclusions:
The authors reported that in persons aged 18–74 years, adenoviral-based vaccines may be associated with increased incidence of MI and PE but no association between mRNA-based vaccines and the cardiovascular events studied was observed.
Perspective:
This nationwide study reports no evidence of a positive association between the mRNA-based Pfizer–BioNTech or Moderna vaccines and acute MI, stroke, or PE in the 3 weeks after each of the first two doses. However, there was a slight increase in risk for PE with the Oxford–AstraZeneca vaccine and for acute MI with the two adenoviral-based vaccines (Oxford–AstraZeneca and Janssen). Of note, vaccination, including with adenoviral-based vaccines, could also decrease risk for a cardiovascular event by limiting the consequences of a potential severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and be overall beneficial.
Clinical Topics: Acute Coronary Syndromes, COVID-19 Hub, Prevention, Vascular Medicine
Keywords: Acute Coronary Syndrome, COVID-19, COVID-19 Vaccines, SARS-CoV-2, Hemorrhagic Stroke, Ischemic Stroke, Myocardial Infarction, Primary Prevention, Pulmonary Embolism, RNA, Messenger, Stroke, Thromboembolism, Vaccination, Vascular Diseases
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