Myocardial Infarction Following Vaccination Against COVID-19: A Systematic Review

Context: 

Several reports have been presented regarding the occurrence of acute myocardial infarction following vaccination against COVID-19.

The current systemic review tried to review and summarize the published evidence and documents regarding the occurrence of myocardial infarction following various types of anti-COVID-19 vaccines (AstraZeneca and Pfizer) and, finally, take steps to clarify the causes of such incidents.

The relevant databases, including Medline, Web of Knowledge, Google Scholar, Scopus, and Cochrane, were comprehensively searched by the two blinded researchers for all eligible studies based on the considered keywords. Of 76 articles initially collected by database searching, 20 articles were included in the last analysis.

The occurrence of acute myocardial infarction was mostly related to SARS-CoV-2-based messenger RNA and viral vector vaccines. This cardiac attack occurred after the first vaccination in 74% of patients affected. The time of occurrence of myocardial infarction was also very different between different types of vaccines and varied between 15 minutes and 21 days after vaccination. Most of the myocardial infarctions that occurred after vaccination were of the ST-segment elevation type (STEMI) (23 of 28 patients). More than two-thirds of myocardial infarction cases occurred in patients who had significant cardiovascular risk profiles (hypertension, diabetes mellitus, and ischemic heart disease). Overall, 22.2% of cases suffering post-vaccination myocardial infarction died within hospitalization.

The occurrence of myocardial infarction following the vaccination against COVID-19 is rare, and due to the fatality of this event, it is necessary to modify the biotechnological production of existing vaccines and to accurately evaluate the pathophysiology of this event.