Abstract WE576: Acute Myocardial Infarction Risk Following COVID-19 Infection and Vaccination in the United States

Introduction: The relationship between COVID-19 infection, COVID-19 vaccination, and myocardial infarction (MI) remains unclear. Characterizing these associations would benefit both clinical practice and public health intervention strategies. Hypothesis: We assessed the hypothesis that both COVID-19 infection and vaccination are associated with MI risk. Methods: Using 2020-2022 All of Us data, a case-control study compared COVID-19 infection during an exposure period of 90 days and a washout period of 2 days between matched on the timing of event MI cases and non-diseased controls. A similar structured study assessed MI following COVID-19 vaccination. Exclusion criteria included prior history of heart disease and missing data for sex or birth date. COVID-19 infection and MI were defined through electronic health records. COVID-19 vaccination status was defined based on the number of doses received. Other covariates included demographics, comorbidities, and cardiovascular medication. Crude and adjusted logistic regression models were used to test the association between COVID-19 infection/vaccination and MI. Results: In the first study, out of 70,282 included participants, around 1% had COVID-19 infection within the 90-day exposure period, and 0.5% suffered MI. In the second study, 37,800 participants were included, of whom 0.34% had MI and 21%, 21%, and 20% received the first, second, and additional (booster or third) doses, respectively. A total of 30.66% participants received any COVID-19 vaccine dose within the exposure period. In both studies, most MI cases were White (65.24% vs 68.99% accordingly) and taking cardiovascular medication (94.51% vs 92.25%), had existing comorbidities (85.06% vs 87.60%), and a mean age older than 64 years. In the 90-day exposure period, COVID-19 infection was associated with a higher odds of an MI when compared to COVID-19 vaccination and the odds of an MI [COVID-19 infection–MI adjusted OR 4.81 (95% CI 2.90-7.98), COVID-19 first dose-MI 1.52 (0.97-2.38), second dose-MI 1.51 (0.96-2.37), additional dose-MI 1.60 (1.05-2.42), and any COVID-19 vaccine-MI 1.11 (0.73-1.67)]. Conclusions: In conclusion, our findings indicated COVID-19 infection was associated with increased odds of MI. In contrast, COVID-19 vaccination was not associated with MI, except for a small increase observed with additional vaccine doses. This contrast may indicate that by reducing serious infection, vaccines may also benefit cardiovascular health.