Patients With ST-Segment Elevation Myocardial Infarction and Cerebrovascular Accidents: Impact of COVID-19 Vaccination on Mortality.

Abstract

Background: Coronavirus disease 2019 (COVID-19) infection is associated with proinflammatory states and adverse health outcomes such as ST-segment elevation myocardial infarction (STEMI) and cerebrovascular accidents (CVA). Limited evidence suggests that COVID-19 vaccination may decrease the adverse impact of COVID-19 infections. This study was designed to determine if patients who received COVID-19 vaccination had lower mortality from STEMI and CVA.

Methods: This is a retrospective comparative analysis of 3,050 patients, who were admitted to the hospital and diagnosed with STEMI or CVA between April 1, 2019, and April 1, 2022. Patients were divided into three different timeframes: pre-COVID (April 1, 2019, to March 31, 2020), COVID (April 1, 2020 to March 31, 2021), and post-COVID (April 1, 2021 to March 31, 2022). Chi-square analysis was completed to analyze associations between STEMI, CVA, and vaccination status. A multinominal logistic regression was used to determine significant predictors for in-hospital mortality.

Results: A total of 3,050 patients were admitted (1,873 STEMI and 1,177 CVA). STEMI accounted for about 60% of cases in each of the three time periods. There was no statistical difference in STEMI or CVA percentages in the three time periods. There was increased mortality in STEMI and CVA patients (odds ratio (OR) = 11.4; P < 0.001), but patients who received the COVID-19 vaccine were less likely to die (OR = 0.51, 95% confidence interval (CI): 0.28 - 0.93; P < 0.027) when compared to those who were unvaccinated. There was increased risk of death in patients with atrial fibrillation (AFIB) (OR = 2.43; P < 0.001) and chronic heart failure (CHF) (OR = 1.76; P = 0.004). There was increased mortality risk associated with age (OR =1.03; P = 0.001). Patients with coronary artery disease (CAD) (OR = 0.45; P = 0.014) and hyperlipidemia (OR = 0.29; P < 0.001) were less likely to die.

Conclusions: Vaccination against COVID-19 was associated with reduced mortality rates in patients hospitalized with STEMI and CVA. Patients with pre-existing cardiovascular comorbidities such as CAD and hyperlipidemia also had lower mortality.