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Jonathan G. Sung

Bio: Jonathan G. Sung is an academic researcher from Brigham and Women's Hospital. The author has contributed to research in topics: Conventional PCI & Myocardial infarction. The author has an hindex of 1, co-authored 2 publications receiving 1 citations.

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TL;DR: In this paper, the authors report two cases of acute myocardial infarction with onset <24 hours after the first dose of a COVID-19 vaccine in patients presenting with shoulder pain.
Abstract: COVID-19 vaccination was launched in the United States in mid-December 2020. There are limited data on the risk of thrombotic events related to COVID-19 vaccines. In conclusion, we report 2 cases of acute myocardial infarction with onset <24 hours after the first dose of a COVID-19 vaccine in patients presenting with shoulder pain.

31 citations

Journal ArticleDOI
TL;DR: In this paper, the authors explore barriers to the use of intracoronary imaging during percutaneous coronary intervention (PCI) and potential strategies to improve the uptake of intra-coronary images in the catheterization laboratory.
Abstract: Intracoronary imaging, including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), has become an increasingly important tool in all stages of invasive coronary disease management, from diagnosis to lesion assessment and percutaneous coronary intervention (PCI) optimization. Despite the robust and growing evidence base supporting imaging-guided PCI, there has been a slow uptake in practice, particularly in the USA. This article aims to explore barriers to the use of intracoronary imaging during PCI and potential strategies to improve the uptake of intracoronary imaging in the catheterization laboratory. Over the past decade, several randomized trials have supported the use of intracoronary imaging in PCI to improve outcome. However, registry data has suggested that the uptake of intracoronary imaging has been particularly slow in the USA. Important barriers to the use of intracoronary imaging include procedural time, cost, perceived risk, and lack of familiarity with imaging use and interpretation. Potential strategies to improve the uptake of intracoronary imaging in the catheterization laboratory include improving training and technical support, monthly audit on PCI imaging data, and incorporation of the prescriptive imaging workflow. Preliminary analysis shows that prescriptive image-guided workflow can reduce contrast and radiation use in procedures, and result in shorter procedure time. Despite the numerous barriers to the use of intracoronary imaging in the catheterization laboratory, these challenges can be overcome to improve patient’s outcome after PCI.

1 citations


Cited by
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Journal ArticleDOI
TL;DR: The findings showed no evidence of an increased risk of MACE after vaccination with BNT162b2 or CoronaVac in patients with CVD, and future research is required to monitor the risk after the third dose of each vaccine.
Abstract: Abstract Aims Concern about the cardiovascular safety of coronavirus disease 2019 (COVID-19) vaccines among individuals with cardiovascular disease (CVD) may lead to vaccine hesitancy. We sought to assess the association between two COVID-19 vaccines, BNT162b2 and CoronaVac, and the risk of major adverse cardiovascular events (MACE) in individuals with established CVD. Methods and results We identified individuals with a history of CVD before 23 February 2021 and a diagnosis of MACE between 23 February 2021 and 31 January 2022 in Hong Kong. MACE was defined as a composite of myocardial infarction, stroke, revascularization, and cardiovascular death. Electronic health records from the Hong Kong Hospital Authority were linked to vaccination records from the Department of Health. A self-controlled case-series method was used to evaluate the risk of MACE for 0–13 and 14–27 days after two doses of COVID-19 vaccine. We estimated incidence rate ratios (IRRs) to compare the risk of MACE between each risk period and the baseline period. A total of 229 235 individuals with CVD were identified, of which 1764 were vaccinated and had a diagnosis of MACE during the observation period (BNT162b2 = 662; CoronaVac = 1102). For BNT162b2, IRRs were 0.48 [95% confidence interval (CI) 0.23–1.02] for the first dose and 0.87 (95% CI 0.50–1.52) for the second dose during the 0–13 days risk period, 0.40 (95% CI 0.18–0.93) for the first dose and 1.13 (95% CI 0.70–1.84) for the second dose during the 14–27 days risk period. For CoronaVac, the IRRs were 0.43 (95% CI 0.24–0.75) for the first dose and, 0.73 (95% CI 0.46–1.16) for the second dose during the 0–13 days risk period, 0.54 (95% CI 0.33–0.90) for the first dose and 0.83 (95% CI 0.54–1.29) for the second dose during the 14–27 days risk period. Consistent results were found in subgroup analyses for different sexes, age groups and different underlying cardiovascular conditions. Conclusion Our findings showed no evidence of an increased risk of MACE after vaccination with BNT162b2 or CoronaVac in patients with CVD. Future research is required to monitor the risk after the third dose of each vaccine.

15 citations

Journal ArticleDOI
David Hana1
TL;DR: In this article , a review of the reported adverse effects of COVID-19 vaccination was conducted and it was found that the incidence of all the reported cardiovascular events is very rare and the benefits of vaccination far outweigh the risk.

15 citations

Journal ArticleDOI
01 Oct 2022-Vaccines
TL;DR:
Abstract: The current report presents the case of a 76-year-old man with Parkinson’s disease (PD) who died three weeks after receiving his third COVID-19 vaccination. The patient was first vaccinated in May 2021 with the ChAdOx1 nCov-19 vector vaccine, followed by two doses of the BNT162b2 mRNA vaccine in July and December 2021. The family of the deceased requested an autopsy due to ambiguous clinical signs before death. PD was confirmed by post-mortem examinations. Furthermore, signs of aspiration pneumonia and systemic arteriosclerosis were evident. However, histopathological analyses of the brain uncovered previously unsuspected findings, including acute vasculitis (predominantly lymphocytic) as well as multifocal necrotizing encephalitis of unknown etiology with pronounced inflammation including glial and lymphocytic reaction. In the heart, signs of chronic cardiomyopathy as well as mild acute lympho-histiocytic myocarditis and vasculitis were present. Although there was no history of COVID-19 for this patient, immunohistochemistry for SARS-CoV-2 antigens (spike and nucleocapsid proteins) was performed. Surprisingly, only spike protein but no nucleocapsid protein could be detected within the foci of inflammation in both the brain and the heart, particularly in the endothelial cells of small blood vessels. Since no nucleocapsid protein could be detected, the presence of spike protein must be ascribed to vaccination rather than to viral infection. The findings corroborate previous reports of encephalitis and myocarditis caused by gene-based COVID-19 vaccines.

15 citations

Journal ArticleDOI
TL;DR: Sung et al. as discussed by the authors showed that the Moderna vaccine can induce an antibody response with a lipid-nanoparticle-encapsulated messenger RNA, whereas the ChAdOx1 nCoV-19 vaccine (AstraZeneca) can trigger an immune response by the n-CoV19 spike protein.
Abstract: In an important report published in the American Journal of Cardiology,1Sung JG Sobieszczyk PS Bhatt DL Acute myocardial infarction within 24 hours after COVID-19 vaccination.Am J Cardiol. 2021; 156: 129-131Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar 2 patients (1 female and 1 male) who received the same COVID-19 vaccine messenger RNA-1273 (Moderna) developed acute myocardial infarction 1 day after the first dose. The authors speculated that the Moderna vaccine can induce an antibody response with a lipid-nanoparticle-encapsulated messenger RNA, whereas the ChAdOx1 nCoV-19 vaccine (AstraZeneca) can trigger an immune response by the nCoV-19 spike protein. Recent reports have shown Kounis hypersensitivity-associated acute myocardial infarction to be associated with other COVID-19 vaccines including BNT162b2 (Pfizer-BioNTech),2Tajstra M Jaroszewicz J Gąsior M Acute coronary tree thrombosis after vaccination for COVID-19.JACC Cardiovasc Intv. 2021; 14: e103-e104Crossref PubMed Scopus (33) Google Scholar Covishield vaccine,3Chatterjee S Ojha UK Vardhan B Tiwari A Myocardial infarction after COVID-19 vaccination-casual or causal?.Diabetes Metab Syndr. 2021; 15: 1055-1056Crossref PubMed Scopus (27) Google Scholar,4Srinivasan KN Sathyamurthy I Neelagandan M Relation between COVID-19 vaccination and myocardial infarction–casual or coincidental?.IHJ Cardiovascular Case Rep. 2021; 5: 71-74Google Scholar and Sinovac (Coronavac)5Özdemir İH, Özlek B, Özen MB, Gündüz R, Bayturan Ö. Type 1 Kounis syndrome induced by inactivated SARS-COV-2 vaccine [published online May 7, 2021]. J Emerg Med doi:10.1016/j.jemermed.2021.04.018.Google Scholar in addition to Moderna2Tajstra M Jaroszewicz J Gąsior M Acute coronary tree thrombosis after vaccination for COVID-19.JACC Cardiovasc Intv. 2021; 14: e103-e104Crossref PubMed Scopus (33) Google Scholar,6Boivin Z Martin J Untimely myocardial infarction or COVID-19 vaccine side effect.Cureus. 2021; 13: e13651PubMed Google Scholar,7Maadarani O Bitar Z Elzoueiry M Nader M Abdelfatah M Zaalouk T Mohsen M Elhabibi M Myocardial infarction post COVID-19 vaccine - coincidence, Kounis syndrome or other explanation - time will tell.JRSM Open. 2021; 1220542704211025259Google Scholar and AstraZeneca.7Maadarani O Bitar Z Elzoueiry M Nader M Abdelfatah M Zaalouk T Mohsen M Elhabibi M Myocardial infarction post COVID-19 vaccine - coincidence, Kounis syndrome or other explanation - time will tell.JRSM Open. 2021; 1220542704211025259Google Scholar Kounis syndrome is a condition associated with hypersensitivity reactions caused by drugs, metals, environmental exposures, conditions, and foods.8Kounis NG Koniari I de Gregorio C COVID-19 and Kounis syndrome: deciphering their relationship.Balkan Med J. 2021; 38: 145-149Crossref PubMed Scopus (11) Google Scholar In a recent report that dealt with 2 patients who developed myocarditis after getting vaccinated with Moderna and Pfizer-BioNTech, respectively, endomyocardial biopsy specimens showed inflammatory infiltrates comprising eosinophils and other interacting inflammatory cells, including T cells, B cells, plasma cells, and macrophages, indicating hypersensitivity reactions.9Verma AK Lavine KJ Lin CY Myocarditis after COVID-19 mRNA vaccination.N Engl J Med. 2021; 385: 1332-1334Crossref PubMed Scopus (130) Google Scholar Indeed, all currently used vaccines contain excipients (constituents of a pharmaceutical form apart from the active substance) that are speculated to induce hypersensitivity reactions. The viral vector Covishield vaccine, which is similar to AstraZeneca and manufactured in India, contains polysorbate 80, disodium edetate dihydrate (ethylenediaminetetraacetic acid), and aluminum hydroxide. The Moderna vaccine contains polyethylene glycol and tromethamine, also known as trometamol. The Pfizer-BioNTech vaccine contains polyethylene glycol. The Johnson & Johnson vaccine contains polysorbate 80. The Sputnik V vaccine contains polysorbate 80 and disodium ethylenediaminetetraacetic acid dehydrate. The Sinovac (Coronavac), which is manufactured in China, contains disodium hydrogen phosphate, sodium dihydrogen phosphate monohydrate, and sodium chloride. These excipients are also found in creams, ointments, lotions, other cosmetics, various dental materials, and anticancer drugs which could sensitize their users. It is estimated that 1% to 5.4% of the population is already sensitized to cosmetics or cosmetic ingredients.10Lyapina MG Stoyanova Dencheva M Contact sensitization to ingredients of dental materials and cosmetics in dental students: a pilot study.Cent Eur J Public Health. 2019; 27: 73-77Crossref PubMed Scopus (14) Google Scholar Free polysorbate oncology medications are already in the market.11Schwartzberg LS Navari RM Safety of polysorbate 80 in the oncology setting.Adv Ther. 2018; 35: 754-767Crossref PubMed Scopus (97) Google Scholar Alternatives to these excipients, such as alkylsaccharides, are promising agents because they can reduce immunogenicity, improve stability, suppress oxidative damage problems, and may prevent thrombotic and cardiovascular events.12Kounis NG Koniari I de Gregorio C Assimakopoulos SF Velissaris D Hung MY Mplani V Saba L Brinia A Kouni SN Gogos C Giovannini M Novembre E Arumugham V Ricke DO Soufras GD Nugent K Sestili P Malone RW COVID-19 disease, women's predominant non-heparin vaccine-induced thrombotic thrombocytopenia and Kounis syndrome: a passepartout cytokine storm interplay.Biomedicines. 2021; 9: 959Crossref PubMed Scopus (13) Google Scholar COVID-19 free allergenic vaccines would be beneficial. The authors have no conflicts of interest to declare.

12 citations