Relationship between acute coronary syndrome and coronavirus disease 2019 infection and vaccination type: a retrospective observational study

BACKGROUND: Studies have reported that the Coronavirus Disease 2019 (COVID-19) vaccine causes other serious health problems, including myocarditis, pericarditis, neurological problems, and problems resulting from the reactivation of chronic infections. There are no satisfactory studies on the relationship between late-stage COVID-19 disease and cardiovascular diseases, or even Acute coronary syndrome (ACS). Our study primarily aimed to compare the frequency of emergency department (ED) visits and mortality rates of patients diagnosed with acute coronary syndrome (ACS) before and after the COVID-19 pandemic. Secondly, we aimed to evaluate differences in demographic and laboratory characteristics between pre-pandemic and post-pandemic ACS patients. Finally, we aimed to investigate the association between COVID-19 vaccination status (unvaccinated, inactivated vaccine, and mRNA vaccine) and mortality outcomes in post-pandemic ACS patients. METHODS: Data from 1,856 patients over the age of 18 diagnosed with ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina pectoris (USAP) in 2023, post-pandemic, and 1,450 patients diagnosed in 2018, pre-pandemic, were analyzed. The incidence of ACS before and after the pandemic, its relationship with the presence of viral vector-based vaccination and mRNA vaccination, and demographic and laboratory results were retrospectively examined. RESULTS: Although the number of emergency department visits nearly doubled after the pandemic, mortality rates were similar (P = 0.595). Troponin I (P < 0.001), creatine kinase-MB (CK-MB) (P < 0.001), and prothrombin time (PT) (P = 0.016) levels were significantly increased in post-pandemic patients. Univariable analysis showed that being unvaccinated was associated with 2.88-fold higher odds of mortality (95% CI: 1.23-6.70), while in the multivariable analysis this association remained significant with 3.77-fold higher odds (95% CI: 1.04-13.65) (p = 0.014 and p = 0.043). Inactivated vaccine [OR 0.60 (95% CI: 0.36-1.01) and p = 0.054] and mRNA vaccine [OR 1.42 (95% CI: 0.85-2.36) and p = 0.177] did not have a significant effect on mortality. CONCLUSIONS: Post-pandemic mortality rates were similar to those before the pandemic. Being unvaccinated was found to be a significant associated with higher mortality. Vaccination type did not affect mortality. Cardiac and inflammatory marker levels were increased in post-pandemic ACS patients compared to pre-pandemic ACS patients.