Acute Myocardial Infarction Within 24 Hours After COVID-19 Vaccination: Is Kounis Syndrome the Culprit?

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. 

http://www.ajconline.org/article/S0002914921009565/pdf

BACKGROUND Vaccines for coronavirus disease 2019 (COVID-19) include ChAdOx1-SARS-COV-2 (AstraZeneca), Ad26.COV2.S (Janssen), mRNA-1273 (Moderna), BNT162b2 (Pfizer), BBIBP-CorV (Sinopharm), CoronaVac (Sinovac), and Bharat Biotech BBV152 (Covaxin). AIM To find the association between COVID-19 vaccines and myocardial infarction (MI). METHODS This is a systematic review that involved searching databases such as MEDLINE, EMBASE, and PakMediNet after making a search strategy using MeSH and Emtree terms. Eligibility criteria were set, and studies having no mention of MI as a complication of COVID-19 vaccination, protocols, genetic studies, and animal studies were excluded. Data was extracted using a predesigned extraction table, and 29 studies were selected after screening and applying the eligibility criteria. RESULTS The majority of studies mentioned AstraZeneca (18 studies) followed by Pfizer (14 studies) and Moderna (9 studies) in subjects reporting MI after vaccination. Out of all the studies, 69% reported MI cases after the first COVID-19 vaccination dose and 14% after the second, 44% reported ST-segment elevation MI, and 26% reported non-ST-segment elevation MI. The mortality rate was 29% after MI. CONCLUSION In conclusion, many studies linked MI to COVID-19 vaccinations, but no definitive association could be found.

https://doi.org/10.12998/wjcc.v10.i28.10109

Link between COVID-19 vaccines and myocardial infarction

Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has caused many complications, the invention of coronavirus disease 2019 (COVID-19) vaccines has also brought about several adverse events, from common side effects to unexpected and rare ones. Common vaccine-related adverse reactions manifest locally or systematically following any vaccine, including COVID-19 vaccines. Specific side effects, known as adverse events of particular interest (AESI), are unusual and need more evaluation. Here, we discuss some of the most critical rare adverse events of COVID-19 vaccines.

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Do we miss rare adverse events induced by COVID-19 vaccination?

Myocarditis has been recognized as a rare complication of coronavirus disease 2019 (COVID-19) mRNA vaccinations. Young adult and adolescent males < 30 years of age are the most commonly affected group, with decreased incidence with older age. This is a case of a 48-year-old male who presented with chest pain and EKG findings of STEMI shortly after receiving the second dose of the Moderna COVID-19 mRNA vaccine. Emergent left heart catheterization revealed normal coronaries. Subsequently, the patient had rapid resolution of his symptoms and improvement in serum markers. The exact etiology factors to this new and rare phenomenon are yet to be fully understood. This patient did have a history of previous viral myocarditis 7 years ago; however, it remains unclear if this could be a predisposing factor to the development of mRNA vaccine-associated myocarditis.

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COVID-19 mRNA Vaccine-Associated Myocarditis Presenting as STEMI in a 48-Year-Old Male

A case of ST elevation myocardial infarction reported post Coronavirus disease 2019 (COVID-19) vaccine. Probably premature to draw a link between COVID-19 vaccine and myocardial infarction.

Myocardial infarction post COVID-19 vaccine - coincidence, Kounis syndrome or other explanation - time will tell.

Myocardial infarction is considered the most common cause of left ventricular pseudoaneurysm. Large missed pseudoaneurysm of the left ventricle incidentally diagnosed and treated conservatively.

https://journals.sagepub.com/doi/pdf/10.1177/20542704211025258

Mohamad Mohsen

Papers

Myocardial infarction post COVID-19 vaccine - coincidence, Kounis syndrome or other explanation - time will tell.

Double heart - chronic large missed pseudoaneurysm of left ventricle.