Myocardial Infarction, Stroke, and Pulmonary Embolism After BNT162b2 mRNA COVID-19 Vaccine in People Aged 75 Years or Older.
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ABSTRACT:
SUBMITTER: Jabagi MJ
PROVIDER: S-EPMC8609457 | biostudies-literature | 2022 Jan
REPOSITORIES: biostudies-literature
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Myocardial Infarction, Stroke, and Pulmonary Embolism After BNT162b2 mRNA COVID-19 Vaccine in People Aged 75 Years or Older.
Jabagi Marie Joelle MJ Botton Jérémie J Bertrand Marion M Weill Alain A Farrington Paddy P Zureik Mahmoud M Dray-Spira Rosemary R
JAMA 20220101 1
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Project description:BackgroundThe BNT162b2 (Pfizer-BioNTech) vaccine has been shown to be safe with regard to risk for severe cardiovascular events (such as myocardial infarction [MI], pulmonary embolism [PE], and stroke) in persons aged 75 years or older. Less is known about the safety of other COVID-19 vaccines or outcomes in younger populations.ObjectiveTo assess short-term risk for severe cardiovascular events (excluding myocarditis and pericarditis) after COVID-19 vaccination in France's 46.5 million adults younger than 75 years.DesignSelf-controlled case series method adapted to event-dependent exposure and high event-related mortality.SettingFrance, 27 December 2020 to 20 July 2021.PatientsAll adults younger than 75 years hospitalized for PE, acute MI, hemorrhagic stroke, or ischemic stroke (n = 73 325 total events).MeasurementsLinkage between the French National Health Data System and COVID-19 vaccine databases enabled identification of hospitalizations for cardiovascular events (MI, PE, or stroke) and receipt of a first or second dose of the Pfizer-BioNTech, mRNA-1273 (Moderna), Ad26.COV2.S (Janssen), or ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccine. The relative incidence (RI) of each cardiovascular event was estimated in the 3 weeks after vaccination compared with other periods, with adjustment for temporality (7-day periods).ResultsNo association was found between the Pfizer-BioNTech or Moderna vaccine and severe cardiovascular events. The first dose of the Oxford-AstraZeneca vaccine was associated with acute MI and PE in the second week after vaccination (RI, 1.29 [95% CI, 1.11 to 1.51] and 1.41 [CI, 1.13 to 1.75], respectively). An association with MI in the second week after a single dose of the Janssen vaccine could not be ruled out (RI, 1.75 [CI, 1.16 to 2.62]).LimitationsIt was not possible to ascertain the relative timing of injection and cardiovascular events on the day of vaccination. Outpatient deaths related to cardiovascular events were not included.ConclusionIn persons aged 18 to 74 years, adenoviral-based vaccines may be associated with increased incidence of MI and PE. No association between mRNA-based vaccines and the cardiovascular events studied was observed.Primary funding sourceNone.
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Project description: Not available
| S-EPMC10074551 | biostudies-literature
Project description:BackgroundThe aim of this study was to provide insight into the real-life clinical presentation and outcomes of the elderly presenting with acute myocardial infarction from the Turkish Myocardial Infarction registry database.MethodsTURKMI was a nationwide, multicenter, observational, 15-day snapshot registry conducted to address the management of acute myocardial infarction patients admitted to percutaneous intervention-capable hospitals. The present analysis included the comparison of consecutively enrolled acute myocardial infarction patients aged ≥75 and <75 years.ResultsOf the overall 1930 patients, 362 patients were aged ≥75 years. Elderly patients were more likely to have hypertension and renal failure and less likely to have hypercholesterolemia. Elderly patients were admitted to hospitals almost 1 hour later mainly due to a late call to emergency medical service. At discharge, medical therapies were significantly less prescribed to the elderly. The proportion of patients undergoing coronary angiography was significantly lower in elderly (81.8% vs. 96.4%, P < .001). Both in-hospital and 1-year mortality were significantly higher in elderly patients (9.1% vs. 2.7% and 22.7% vs. 5.8%, P < .001 respectively). The adjusted risk of 1-year mortality was 4-fold in elderly (hazard ratio and 95% CI 4.0 [2.9-5.6], P < .001). In multivariate analysis, every 5-beat/min increase in heart rate increased mortality by 7%. Higher heart rate and use of antiplatelet agents on admission were predictors of mortality in elderly.ConclusionIn real-life settings, elderly patients presenting with acute myocardial infarction are prone to prolonged total ischemic time and are subjected to less-intensive medical treatment and interventional approaches. Besides age, the increased heart rate could be the major determinant of mortality.
| S-EPMC9366416 | biostudies-literature
Project description:BackgroundOlder adults are given high priority for coronavirus disease 2019 (COVID-19) vaccination; however, little is known about the safety of vaccines. This study was conducted to examine the safety of the COVID-19 vaccine for people who were ≥ 75 years of age, specifically those who first took two doses of the vaccine at the COVID-19 central vaccination center in South Korea.MethodsSafety monitoring after the BNT162b2 vaccine was conducted in three ways for older adults who received the first dose of the vaccine at our center between April 5 and April 23, 2021. For immediate adverse reactions, every person who was vaccinated was observed for 15-30 minutes after injection at the center. For active surveillance, a telephone interview was conducted for stratified randomly sampled people after 7 days of each vaccination to enquire regarding types of adverse reactions they experienced, and its severity and duration. For passive surveillance, reported adverse event data were collected from the COVID-19 vaccine adverse event following immunization (AEFI) surveillance system-run by the Korea Disease Control and Prevention Agency (KDCA). The data were then reviewed.ResultsIn total, 2,123 older adults received at least one vaccine dose during the study period. The frequency of acute adverse reactions that developed during the observed 15-30 minutes after injection was 8.5 cases per 1,000 doses. None of the reactions was assessed as acute allergic reactions to the vaccine and no cases required special treatment or drug administration. Overall, 638 people were followed up at least once by telephone interview 7 days post vaccination. The overall response rate was 82.3%. The rates of local reactions were 50.3% after the first dose and 45.2% after the second dose, and the rates of systemic reactions were 15.2% and 26.0%, respectively. During the study period, 23 medically attended adverse events (5.4 cases per 1,000 administered doses) were reported to the KDCA AEFI surveillance system. The most common symptoms of medically attended cases were nonspecific general weakness (26%) and dizziness (26%), followed by muscle pain (22%), headache (13%), fever (13%), and skin rash or urticaria (13%). Among them, there were five serious adverse events reported, which required hospitalization, including one death. However, most of them were not related to the vaccines.ConclusionBNT162b2 vaccination was tolerable among adults who were ≥ 75 years of age.
| S-EPMC8608922 | biostudies-literature
Project description:Background and Objectives: Body mass index (BMI) is widely used as a standard screening method for obesity and an indicator of related diseases. However, its inability to distinguish between lean body mass and body fat limits its utility. This limitation may be more prominent in older populations, wherein age-related sarcopenia and increased visceral fat due to the redistribution of adipose tissue may preclude a precise estimation of obesity. Many studies suggest that waist circumference (WC) is more strongly related to obesity-related diseases. There are also different opinions on whether the obesity paradox is real or a result of confusing interpretations. This study seeks to determine the association between myocardial infarction (MI), BMI, and WC in older adults and to determine if BMI and WC can reliably predict the risk of cardiovascular disease. Materials and Methods: We conducted a cohort study of older Korean adults aged over 75 years registered in the National Health Insurance System Senior database. Results: The results from the analysis using model 5, which was adjusted for each study variable, showed that the lower the BMI, the higher the hazard ratio (HR) of MI and vice versa. On the other hand, groups with lower than normal WC showed lower HR; even if it was higher, the difference was not statistically significant. Those with abdominal obesity tended to have an increased HR of MI. Conclusions: This study found that HR for MI has a negative relationship with BMI, whereas it has a positive relationship with WC. Furthermore, WC is a more appropriate indicator for predicting the risk of MI in the older population.
| S-EPMC9783624 | biostudies-literature
Project description:BackgroundIschemic stroke, myocardial infarction (MI), and pulmonary embolism (PE) are emergent conditions which can be treated with catheter-directed therapies. Concomitant management of these conditions with catheter-directed therapy is not well-documented and lacks strong guidelines.Case summaryA 70-year-old woman presented with stroke symptoms and ST-segment elevation MI. Rapid stroke protocol imaging confirmed ischemic stroke and extensive bilateral PE. To address these conditions rapidly and because of contraindications for systemic thrombolysis, she underwent percutaneous coronary intervention without stenting, stroke thrombectomy, and finally pulmonary thrombectomy.DiscussionThis case provides insight into the management of a patient with 3 emergent pathologies with catheter-directed therapy. We also provide reasoning for decisions such as vena cava filter placement and forgoing coronary stent placement.Take-home messagesThis extreme case highlights the use of catheter-directed therapy for a scenario which lacks clear guidelines. Catheter-directed therapy was successfully used to treat ischemic stroke, MI, and PE in a complex patient, resulting in her full recovery.
| S-EPMC11861931 | biostudies-literature
Project description:IntroductionTelomere length (TL) is generally regarded as a biomarker of aging. TL, which is influenced by sociodemographic factors, has been shown to be inversely associated with morbidity. However, most studies examined the youngest, and whether the findings can be extended to older individuals is less clear. Further, few studies have examined these questions in Chinese older adults. This cross-sectional study examined TL and its associated factors in Chinese aged 75+ years in Hong Kong.MethodsParticipants were from the Mr. and Ms. Osteoporosis cohort. A structured interview on sociodemographic factors and physical measurement was conducted. Frailty and sarcopenia status were respectively determined by Fried's criteria and the Asian Working Group for Sarcopenia definition. TL was measured by a molecular inversion probe-quantitative PCR assay and expressed as a novel telomere/a single copy reference gene (T/S) ratio. Adjusted binary logistic regressions were used to examine the associations between TL and the presence of multimorbidity, age-related diseases, frailty, and sarcopenia.ResultsAmong 555 participants (mean age 83.6 ± 3.8 years, 41.3% females), the mean T/S ratio was 1.01 ± 0.20. Males had a lower T/S ratio (0.97 ± 0.20) compared with females (1.07 ± 0.18) (p < 0.001). A lower education level was related to a longer TL (p = 0.016). Being a current smoker was related to a shorter TL (p = 0.007). TL was not significantly different across categories of age, subjective socioeconomic status, drinking status, physical activity level, and body mass index (p > 0.05). There were no associations between TL and the presence of multimorbidity, diabetes, stroke, cardiovascular diseases, cognitive impairment, frailty, and sarcopenia.ConclusionAmong Chinese aged 75+ years, males had shorter TL compared with females. TL was not associated with age-related diseases, frailty, and sarcopenia in this age group. TL may not be a biological marker of aging among older individuals.
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Project description:We present a spectrum of findings with transthoracic echocardiography, coronary angiography, and open surgical exploration in a 54-year-old man who presented with an acute ST segment elevation myocardial infarction and was diagnosed with impending paradoxical emboli. He underwent successful surgical removal of the thrombus.Learning objectiveImpending paradoxical embolism, a biatrial thromboembolus in transit across a patent foramen ovale, is associated with a 20% mortality rate. Very rarely does it present as a ST segment elevation myocardial infarction. The optimal management (medical or surgical) for those who present with it remains a subject of debate, although surgery has been associated with less systemic embolization.
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Project description:ImportanceDuring the past decades, improvements in the prevention and management of myocardial infarction, stroke, and pulmonary embolism have led to a decline in cardiovascular mortality in the general population. However, it is unknown whether patients receiving dialysis have also benefited from these improvements.ObjectiveTo assess the mortality rates for myocardial infarction, stroke, and pulmonary embolism in a large cohort of European patients receiving dialysis compared with the general population.Design, setting, and participantsIn this cohort study, adult patients who started dialysis between 1998 and 2015 from 11 European countries providing data to the European Renal Association Registry were and followed up for 3 years. Data were analyzed from September 2020 to February 2022.ExposuresStart of dialysis.Main outcomes and measuresThe age- and sex-standardized mortality rate ratios (SMRs) with 95% CIs were calculated by dividing the mortality rates in patients receiving dialysis by the mortality rates in the general population for 3 equal periods (1998-2003, 2004-2009, and 2010-2015).ResultsIn total, 220 467 patients receiving dialysis were included in the study. Their median (IQR) age was 68.2 (56.5-76.4) years, and 82 068 patients (37.2%) were female. During follow-up, 83 912 patients died, of whom 7662 (9.1%) died because of myocardial infarction, 5030 (6.0%) died because of stroke, and 435 (0.5%) died because of pulmonary embolism. Between the periods 1998 to 2003 and 2010 to 2015, the SMR of myocardial infarction decreased from 8.1 (95% CI, 7.8-8.3) to 6.8 (95% CI, 6.5-7.1), the SMR of stroke decreased from 7.3 (95% CI, 7.0-7.6) to 5.8 (95% CI, 5.5-6.2), and the SMR of pulmonary embolism decreased from 8.7 (95% CI, 7.6-10.1) to 5.5 (95% CI, 4.5-6.6).Conclusions and relevanceIn this cohort study of patients receiving dialysis, mortality rates for myocardial infarction, stroke, and pulmonary embolism decreased more over time than in the general population.
| S-EPMC9016490 | biostudies-literature
Project description:The immune factors associated with impaired SARS-CoV-2 vaccine response in elderly people are mostly unknown. We studied individuals older than 60 and younger than 60 years, who had been vaccinated with SARS-CoV-2 BNT162b2 mRNA, before and after the first and second dose. Aging was associated with a lower anti-RBD IgG levels and a decreased magnitude and polyfunctionality of SARS-CoV-2-specific T cell response. The dramatic decrease in thymic function in people > 60 years, which fueled alteration in T cell homeostasis, and their lower CD161+ T cell levels were associated with decreased T cell response 2 months after vaccination. Additionally, deficient DC homing, activation, and TLR-mediated function, along with a proinflammatory functional profile in monocytes, were observed in the > 60-year-old group, which was also related to lower specific T cell response after vaccination. These findings might be relevant for the improvement of the current vaccination strategies and for the development of new vaccine prototypes.
| S-EPMC9536264 | biostudies-literature