Vaccines and myocardial injury in patients hospitalized for COVID-19 infection: the CardioCOVID-Gemelli study

Background Myocardial injury is prevalent among patients hospitalized for COVID-19. However, the role of COVID-19 vaccines in modifying the risk of myocardial injury is unknown. Aims To assess the role of vaccines in modifying the risk of myocardial injury in COVID-19. Methods and results We enrolled COVID-19 patients admitted from March 2021 to February 2022 with known vaccination status and >= 1 assessment of hs-cTnI within 30 days from the admission. The primary endpoint was the occurrence of myocardial injury (hs-cTnI levels >99th percentile upper reference limit). A total of 1019 patients were included (mean age: 67.7 +/- 14.8 years, 60.8% male, and 34.5% vaccinated against COVID-19). Myocardial injury occurred in 145 (14.2%) patients. At multivariate logistic regression analysis, advanced age, chronic kidney disease, and hypertension, but not vaccination status, were independent predictors of myocardial injury. In the analysis according to age tertiles distribution, myocardial injury occurred more frequently in the III tertile (>= 76 years) compared with other tertiles (I tertile: <= 60 years; II tertile: 61-75 years) (P < 0.001). Moreover, in the III tertile, vaccination was protective against myocardial injury [odds ratio (OR): 0.57, 95% confidence interval (CI): 0.34-0.94; P = 0.03], while a previous history of coronary artery disease was an independent positive predictor. In contrast, in the I tertile, chronic kidney disease (OR: 6.94, 95% CI: 1.31-36.79, P = 0.02) and vaccination (OR: 4.44, 95% CI: 1.28-15.34, P = 0.02) were independent positive predictors of myocardial injury. Conclusion In patients >= 76 years, COVID-19 vaccines were protective for the occurrence of myocardial injury, while in patients <= 60 years, myocardial injury was associated with previous COVID-19 vaccination. Further studies are warranted to clarify the underlying mechanisms.