Associations of COVID-19 vaccination with risks for post-infectious cardiovascular complications: an international cohort study in cancer patients with SARS-CoV-2 infection

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas Pub Date : 2025-03-06 DOI:10.1016/j.lana.2025.101038

Emily Pei-Ying Lin , Chih-Yuan Hsu , Sanjay Mishra , Elizabeth A. Griffiths , Brahm H. Segal , Clara Hwang , Sunny R.K. Singh , Nino Balanchivadze , Chinmay Jani , Melissa G. Mariano , Padmanabh S. Bhatt , Kendra Vieira , Peter Paul Yu , Eric J. Oligino , Trisha Wise-Draper , Elizabeth K. Ferrara , Rana R. McKay , Taylor K. Nonato , Chris Labaki , Eddy Saad , Yu Shyr

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Abstract

Background

Whether COVID-19 vaccination is associated with risks for cardiovascular complications after SARS-CoV-2 infection in patients with cancer is unknown. The objective of this study was to investigate the associations between the two.

Methods

This registry (COVID-19 and Cancer Consortium)-based retrospective cohort study included patients with laboratory-confirmed SARS-CoV-2 infection from the United States, Canada, and Mexico between April 2021 and December 2022. Patients without COVID-19 vaccination were assigned to the unvaccinated group and patients with ≥2 doses of COVID-19 vaccination were assigned to the fully-vaccinated group. The primary outcome was a composite of post-infectious cardiac complications, including acute myocardial infarction, other ischemic heart disease, atrial fibrillation, ventricular fibrillation, other arrhythmias, cardiomyopathy, and congestive heart failure. The secondary outcome was a composite measure of post-infectious cardiovascular events, comprising of the cardiac complications along with pulmonary embolism, deep vein thrombosis, superficial vein thrombosis, other thrombosis, and cerebrovascular stroke. Multivariable logistic regression was used for data analysis.

Findings

A total of 2729 patients were included for analyses, with 1382 in the unvaccinated group and 1347 in the fully-vaccinated group. The median age of the study population was 65 (interquartile range (IQR), 55–74) years. Overall, 1534 (56.0%) were women; 1272 (47%) were never smokers; 1639 (60%) were not obese; 2043 (75%) had stable cancer, and 446 (16%) took anticoagulants at baseline. The primary and secondary analyses showed lower risks of cardiac complications and cardiovascular events in the fully-vaccinated group, with adjusted odds ratios (aOR) of 0.66 (95% confidence interval (CI), 0.48–0.89) and 0.76 (95% CI, 0.59–0.99), respectively. The protective trend with COVID-19 vaccination was observed across infections with different dominant SARS-CoV-2 strains and in patients with or without anticoagulant use.

Interpretation

COVID-19 vaccination was associated with a reduced risk of cardiac complications and cardiovascular events by 34% and 24%, respectively, after SARS-CoV-2 infection in patients with cancer.

Funding

National Institutes of Health USA; National Science and Technology Council of Taiwan.

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背景：目前尚不清楚COVID-19疫苗接种是否与癌症患者感染SARS-CoV-2后心血管并发症的风险相关。本研究的目的是调查两者之间的联系。方法这项基于注册表（COVID-19和癌症协会）的回顾性队列研究纳入了2021年4月至2022年12月期间来自美国、加拿大和墨西哥的实验室确诊的SARS-CoV-2感染患者。未接种COVID-19疫苗的患者分为未接种组，接种≥2剂COVID-19疫苗的患者分为完全接种组。主要结局是感染后心脏并发症的综合，包括急性心肌梗死、其他缺血性心脏病、心房颤动、心室颤动、其他心律失常、心肌病和充血性心力衰竭。次要终点是感染后心血管事件的综合测量，包括心脏并发症以及肺栓塞、深静脉血栓形成、浅静脉血栓形成、其他血栓形成和脑血管卒中。采用多变量logistic回归进行数据分析。共纳入2729例患者进行分析，其中1382例来自未接种疫苗组，1347例来自完全接种疫苗组。研究人群的中位年龄为65岁（四分位间距，55-74岁）。总体而言，1534例（56.0%）为女性；从不吸烟的1272人（47%）；1639例（60%）不肥胖；2043例（75%）癌症稳定，446例（16%）在基线时服用抗凝剂。初级和次级分析显示，完全接种疫苗组心脏并发症和心血管事件的风险较低，调整优势比（aOR）分别为0.66（95%可信区间（CI） 0.48-0.89）和0.76 （95% CI, 0.59-0.99）。在不同优势SARS-CoV-2毒株感染以及是否使用抗凝剂的患者中，观察到COVID-19疫苗接种的保护趋势。在癌症患者感染SARS-CoV-2后，covid -19疫苗接种与心脏并发症和心血管事件的风险分别降低34%和24%相关。美国国立卫生研究院；

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来源期刊

Lancet Regional Health-Americas Multiple-

CiteScore

8.00

自引率

0.00%

发文量

期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.