Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA Network Open, 7(5), e2413946. https://doi.org/10.1001/jamanetworkopen.2024.13946 Dr. Henrique Andrade Fonseca et al.
Points
- This study investigates the impact of COVID-19 vaccination on cardiopulmonary events in high-risk cardiovascular patients by conducting a secondary analysis of the VIP-ACS trial.
- Among 1801 participants, 16.2% had a prior myocardial infarction, and 35.7% were active smokers. Landmark analysis compared cardiopulmonary event incidence between vaccinated and unvaccinated patients.
- The incidence of the primary endpoint per 100 patient-years was 9.37 for unvaccinated individuals and 4.81 for those who received at least one COVID-19 vaccine dose. The adjusted hazard ratio for the primary endpoint was 0.41.
- Most vaccinated participants received at least one dose of the Oxford/AstraZeneca (ChAdOx1) viral vector vaccine.
- COVID-19 vaccination post-ACS did not significantly reduce cardiopulmonary events or major adverse cardiovascular events compared to unvaccinated individuals, highlighting the need for further research to understand the vaccine’s impact on cardiovascular outcomes in high-risk populations.
Summary
COVID-19 vaccines have demonstrated efficacy in reducing hospitalizations and mortality rates. However, their effectiveness in lowering the occurrence of cardiopulmonary events in a high-risk population for cardiovascular issues remains unexplored. This study conducts a secondary analysis of the Vaccination Against Influenza to Prevent Cardiovascular Events After Acute Coronary Syndromes (VIP-ACS) trial to investigate the impact of COVID-19 vaccination on cardiopulmonary events in patients at risk of cardiovascular events.
The study, approved by the Comitê de Ética em Pesquisa-Hospital Israelita Albert Einstein, followed the CONSORT reporting guideline. Patients were not randomized to COVID-19 vaccines. A prespecified analysis compared the incidence of cardiopulmonary events in Brazil’s patients who received COVID-19 vaccination. Patients who received at least 1 COVID-19 vaccine dose were classified as vaccinated and censored from the unvaccinated group. Landmark analysis was applied to minimize ascertainment immortal bias.
Among 1801 participants, 16.2% had a prior myocardial infarction, and 35.7% were active smokers. In the 90-day event-free follow-up analysis, the incidence of the primary endpoint per 100 patient-years was 9.37 for unvaccinated individuals vs. 4.81 for those who received at least one vaccine dose. The adjusted hazard ratio for the primary endpoint was 0.41 (95% CI, 0.18-0.94; P = .12). Most individuals received at least one viral vector vaccine (Oxford/AstraZeneca [ChAdOx1]) dose during follow-up.
This secondary analysis suggests that COVID-19 vaccination post-ACS did not significantly reduce cardiopulmonary or major adverse cardiovascular events compared to unvaccinated individuals. Further research is needed to clarify the impact of COVID-19 vaccination on cardiovascular outcomes in high-risk populations, considering potential confounding factors and limitations of the study design.
Link to the article: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2819205
References Fonseca, H. A. R., Damiani, L. P., Monfardini, F., Zimerman, A., Rizzo, L. V., & Berwanger, O. (2024). COVID-19 Vaccination and Cardiopulmonary Events After Acute Coronary Syndromes: A Secondary Analysis of a Randomized Clinical Trial. JAMA Network Open, 7(5), e2413946. https://doi.org/10.1001/jamanetworkopen.2024.13946
