背景:癌症患者患心血管疾病的风险增加,并且易患2019年冠状病毒病(COVID-19)感染。我们旨在评估韩国癌症患者接种COVID-19疫苗的心血管安全性。
方法:我们使用K-COV-N队列(2018-2021年)进行了自我对照病例系列研究。确定了12岁或以上的癌症患者,他们经历了心血管疾病的结局。心血管结局定义为心肌梗死,中风,静脉血栓栓塞症(VTE),心肌炎,或者心包炎,危险期为接受每剂COVID-19疫苗后0-28天。使用条件泊松回归模型以95%置信区间(CI)计算发病率比率(IRR)。
结果:在318,105名癌症患者中,纳入了4,754例心血管结局患者。总体心血管风险没有增加(调整后的IRR,0.99[95%CI,0.90-1.08])在整个风险期内。在mRNA疫苗亚组中,根据疫苗类型在整个风险期内调整的总心血管结局的IRRs为1.07(95%CI,0.95-1.21),ChAdOx1nCoV-19疫苗亚组的0.99(95%CI,0.83-1.19),和0.86(95%CI,0.68-1.10)在混合匹配的疫苗接种亚组。然而,在对个体结果的分析中,在整个危险期,心肌炎的校正IRR增加至11.71(95%CI,5.88~23.35).相比之下,未观察到其他结局的风险增加,比如心肌梗塞,中风,VTE,和心包炎.
结论:对于癌症患者,COVID-19疫苗接种在心血管结局方面表现出总体安全的特征。然而,需要谨慎,因为在这项研究中观察到接种COVID-19疫苗后心肌炎的风险增加。
BACKGROUND: Cancer patients have an increased risk of cardiovascular outcomes and are susceptible to coronavirus disease 2019 (COVID-19) infection. We aimed to assess the cardiovascular safety of COVID-19 vaccination for cancer patients in South Korea.
METHODS: We conducted a self-controlled case series
study using the K-COV-N cohort (2018-2021). Patients with cancer aged 12 years or older who experienced cardiovascular outcomes were identified. Cardiovascular outcomes were defined as myocardial infarction, stroke, venous thromboembolism (VTE), myocarditis, or pericarditis, and the risk period was 0-28 days after receiving each dose of COVID-19 vaccines. A conditional Poisson regression model was used to calculate the incidence rate ratio (IRR) with 95% confidence interval (CI).
RESULTS: Among 318,105 patients with cancer, 4,754 patients with cardiovascular outcomes were included. The overall cardiovascular risk was not increased (adjusted IRR, 0.99 [95% CI, 0.90-1.08]) during the whole risk period. The adjusted IRRs of total cardiovascular outcomes during the whole risk period according to the vaccine type were 1.07 (95% CI, 0.95-1.21) in the mRNA vaccine subgroup, 0.99 (95% CI, 0.83-1.19) in the ChAdOx1 nCoV-19 vaccine subgroup, and 0.86 (95% CI, 0.68-1.10) in the mix-matched vaccination subgroup. However, in the analysis of individual outcome, the adjusted IRR of myocarditis was increased to 11.71 (95% CI, 5.88-23.35) during the whole risk period. In contrast, no increased risk was observed for other outcomes, such as myocardial infarction, stroke, VTE, and pericarditis.
CONCLUSIONS: For cancer patients, COVID-19 vaccination demonstrated an overall safe profile in terms of cardiovascular outcomes. However, caution is required as an increased risk of myocarditis following COVID-19 vaccination was observed in this
study.