背景:COVID-19大流行对动脉粥样硬化血栓形成(1型MI)引起的急性心肌梗死(MI)患者的严重程度和预后产生不利影响。效果,如果有的话,这些患者的COVID-19疫苗接种和自然SARS-CoV2血清学免疫尚不清楚。我们的目的是分析1型MI患者的严重程度和预后与他们以前的SARS-CoV2疫苗接种和血清状态之间的关系。
方法:2020年3月1日至2023年3月1日进行的单中心回顾性队列研究。从病历和患者中收集临床和随访信息。总抗体(IgM,IgA,通过ECLIA(基于电化学发光的免疫测定法)测量IgG)对核衣壳(N)抗原的影响,以测试对自然感染的免疫反应。如果是积极的,通过CLIA测量针对刺突(S)表面抗原的IgM和IgG抗体以测试对疫苗或自然感染的免疫应答。进行多变量logistic回归分析,调整年龄,性别,高血压,糖尿病,和血脂异常。
结果:949名患者的总样本,656的ST段抬高MI(STEMI)和293的非ST段抬高MI(NSTEMI)。平均年龄为64(SD13)岁,80%的男性入院前疫苗接种状态为:≥1剂,53%的患者;完成疫苗接种,49%;首次加强剂量,25%。大多数(84%)的疫苗是基于mRNA的。MI后六个月,92例(9.7%)患者发生重大不良心脏事件(MACE),50例死亡;11%的患者在STEMI后发生严重心力衰竭或心源性休克(KillipIII-IV)。接种STEMI且血清学阳性的患者(Pos/Vax组)入院时发生KillipIII-IV的风险较高:OR2.63(1.27-5.44),p=0.010。SARS-CoV-2S特异性IgG滴度在该组中最高(中位数>2080AU/mL,[IQR1560->2080]vs未接种组的91[32-198])。在整个样本中,未显示6个月MACE发生率较高(OR1.89[0.98-3.61],p=0.055)。
结论:疫苗接种和自然SARS-CoV2感染的组合与STEMI患者严重心力衰竭和心源性休克的发展有关,可能与血清学反应增加有关。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.